OBJECTIVES: The Institute of Clinical and Economic Review (ICER) is an independent, non-profit organization conducting value assessment for health interventions in the United States (US). In 2015, ICER released its value framework with decision driven by cost-effectiveness and budget impact. The aim of the study was to analyse value-based prices (VBPs) and price discounts needed to achieve cost-effectiveness thresholds for medicines assessed by ICER since 2015.

METHODS: ICER reports published since 2015 on topics involving drugs were obtained from ICER’s website. Data on unit prices as wholesale acquisition cost (WAC), VBPs and discounts required to achieve thresholds of $100,000/QALY and $150,000/QALY were extracted. If discounts were not available, they were calculated using unit prices and VBPs.

RESULTS: Reports on 17 different topics were included, which translated into 88 assessment cases accounting for new drug or class reviews in one indication and potential subgroups under specific indication. For 15 cases data on unit prices or VBPs were missing, thus they were excluded from further analysis. Among remaining 73 cases, only 16 (22%) were classified as representing good value for money, having prices below or between VBPs for thresholds of $100k and $150K/QALY. Remaining 57 cases (78%) required broad range of discounts to achieve cost-effectiveness thresholds. The lowest discount was expected for Insulin Degludec in the type 2 diabetes basal-bolus population (2% and 7% to achieve $150k and $100k/QALY, respectively), while the highest discount was needed for Ixazomib in multiple myeloma (85% and 97% for both thresholds respectively).

CONCLUSIONS: The majority of analysed prices did not align with potential drug value and would need to be substantially reduced to achieve cost-effectiveness thresholds. While US payers are scrutinising value frameworks such as ICER to better support their decision-making, it will be key for pharma companies to engage early with ICER on drug assessment.