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Report: Targeted DMARDs Need to Have Discounts to be Cost-effective for RA
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According to an evidence report by the Institute for Clinical and Economic Review, targeted disease-modifying antirheumatic drugs need to have discounts between 29% and 69%, depending on each drug, in order to meet commonly accepted thresholds for cost-effectiveness.
“Our report found that many [targeted immune modulators] TIMs offer substantial clinical benefit to patients as compared to conventional disease-modifying antirheumatic drug (DMARD) therapy alone,” Steven D. Pearson, MD, MSc, Institute for Clinical and Economic Review (ICER) President, said in a press release about the report. “However, our report also concluded that evidence to distinguish the effectiveness among different TIMs is quite limited, and current prices of all TIMs are not well-aligned with the added benefit they provide for patients.”
The ICER evaluated the evidence of targeted DMARDs (tDMARDs) — which they defined as TIMs and included both biologics and Janus kinase inhibitors — used alone or in combination with conventional synthetic DMARDs (csDMARDs) and compared with csDMARDs alone.
The report showed all drugs had a small net health benefit. Pearson and colleagues used data provided by SSR Health to determine drug discounts. Results varied from $168,660 for subcutaneous tocilizumab to $271,749 for tofacitinib per quality-adjusted life year gained. In addition, they found rituximab (Rituxan, Genentech), intravenous abatacept (Orencia, BMS), intravenous or injection tocilizumab (Actemra, Genentech), certolizumab pegol (Cimzia, UCB), intravenous or injection golimumab (Simponi and Simponi Aria, Janssen) and infliximab (Remicade, Janssen) were all more effective and less costly than adalimumab (Humira, AbbVie), the market leader. Overall, they found there would need to be discounts, which ranged from 29% to 69% for the drugs, for the medications to meet commonly accepted thresholds for cost-effectiveness.
“These results raise important questions about existing pricing and coverage policies,” Pearson said. “An important goal of our report and meeting will be to explore these issues and identify actions that can be taken to help improve the effectiveness and the value of care for all patients with [rheumatoid arthritis] RA.”
Reference:
https://icer-review.org/announcements/ra-evidence/
Perspective
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Louis Tharp
Regardless of your perspective — that of innovator, health care provider, payer or patient — it is true that health care costs are out of control in the United States. There is a need to have thoughtful and data-driven debates about how to advance our understanding of chronic diseases, like rheumatoid arthritis, so patients and physicians can make informed treatment decisions and then access medications affordably and easily.
While the Institute of for Clinical and Economic Review’s (ICER) purported mission is to evaluate the intersection between treatment effectiveness and cost, its premise is biased because its funding stems from the insurance industry and a majority of its board are tied to the health insurance industry.
Although flawed in several ways, one of our main objections to ICER’s new rheumatoid arthritis (RA) evidence report is that it overvalues suppression of symptoms using conventional synthetic disease-modifying antirheumatic drugs over the longer-term benefits enjoyed by patients who reduce their risk for possible joint degradation by the use of more complex and more expensive, biologic medicines. Biologics are known to treat the underlying cause of the disease and often allow people with RA greater mobility and functionality. ICER is incredibly short-sighted to discount the economic benefits of quality of life measures, instead focusing on short-term clinical studies. Clinical studies are not about treating patients in real life, but rather, about achieving an endpoint in a specific patient type. In the real-world, the arthritis community and rheumatologists understand the value of biologics, yet ICER’s analysis will likely result in sustained financial and administrative barriers to access. The cheapest and oldest drugs are not always the best.
Our organization discloses our purpose, funders and partners. Similarly, it is time to insist that ICER’s research methodology and funding become more transparent to encourage real conversation about treatment value.
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