OBJECTIVES: Rarely do discussions on value-based drug prices (VBPs) highlight the relative contribution of health gains and cost-offsets. Our objective was to explore the extent to which VBPs are driven by health gains and cost-offsets using interventions evaluated by the Institute for Clinical and Economic Review (ICER).

METHODS: Data were analyzed from all economic models included in ICER’s Interactive Modeler. For each intervention, the condition, comparator, incremental costs, incremental life-years, and incremental quality adjusted life years (QALYs) were extracted. A VBP defined using a cost-effectiveness analysis framework for each intervention was calculated by summing the value of health gains (QALYs) and the value of cost-offsets over the lifetime of the model using a $150,000/QALY threshold. The extent to which the VBP was driven by health gains and cost-offsets was based on the percent contribution to the VBP. Only drugs with positive incremental total QALYs and costs were included. Relationships between model characteristics and percentage of VBP driven by health gains were explored.

RESULTS: A total of 86 drug/indication combinations were included. The percentage of VBPs driven by health gains ranged from 0% to 100% (mean: 66%; standard deviation 33%). On average, drugs with active comparators had lower percentages of VBPs from health gains compared to drugs without active comparators (56% vs 73%). Drugs generating life extension had higher percentages of VBPs from health gains compared to drugs that did not (74% vs 50%). For single and short-term therapies (SSTs), the percentages of VBPs from health gains ranged from 1%-3% (valoctocogene roxaparvovec, etranacogene dezaparvovec) to 100% (axicabtagene ciloleucel, onasemnogene abeparvovec-xioi).

CONCLUSIONS: The percentages of VBPs driven by health gains varied by condition and intervention. Some SSTs derive high VBPs with only nominal (1-2%) contributions from health gains. Deconstructing the building blocks of VBPs offers additional insights to inform deliberations on drug pricing and value.