OBJECTIVES: Current practice in cost-effectiveness analysis (CEA) involves estimating the incremental cost-effectiveness ratio (ICER) in a pairwise comparison between a new intervention and one alternative comparator, which may fail to capture the full impact of bringing the intervention to market. A multi-comparator ICER (MC-ICER) would account for wider changes in clinical practice after introducing a new technology, providing a more comprehensive assessment of value than traditional cost-effectiveness measures.

METHODS: A MC-ICER was estimated evaluating the impact of a new technology, brodalumab, on all comparators in US clinical practice for moderate-to-severe psoriasis which are impacted by the new technology, rather than a theoretical ‘second-best’ alternative only. Published cost and quality-adjusted life year (QALY) inputs were used. By weighting incremental costs and benefits for each comparator against brodalumab by their change in market share, a MC-ICER was generated.

RESULTS: The traditional ICER against the second-best alternative was $140,556/QALY while the MC-ICER was $50,709/QALY (63.92% lower). Unlike a traditional CEA, this reflected the fact that patients treated with brodalumab would otherwise receive one of a variety of comparators, not limited to the second-best alternative given the standard cost-effectiveness frontier. The difference between the traditional ICER and the MC-ICER depends on how the new technology impacts the prescribing patterns of all comparators.

CONCLUSIONS: Limitations with traditional CEA approaches have been identified. The proposed framework was designed to find the broader value of a new treatment, which may be understated when using a pairwise comparison. By considering all comparators and patients affected by the introduction of a new technology, the framework presents results more relevant to the policymaker, as they reflect clinical practice. When making healthcare resourcing decisions, it is important to estimate the value of a new technology based on real world impact, through scenarios reflecting prescribing changes. This may be used alongside a traditional ICER.