March 14, 2017
An evidence report, released the Institute for Clinical and Economic Review (ICER), found that while targeted immunomodulatory drugs for patients diagnosed with rheumatoid arthritis (RA) have significant clinical value, they are not cost-effective at current prices.
The report examined targeted immune modulators (TIMs) that were used alone or in combination with conventional disease-modifying anti-rheumatic drugs (DMARDs), compared to conventional DMARDs alone. The report reviewed the clinical effectiveness, potential harms, and comparative value of treating patients with moderately to severely active RA who have had an inadequate response to conventional DMARDs.
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The ICER report reviewed TNF inhibitors, CD20-directed cytolytic antibodies, T-cell inhibitors, IL-6 inhibitors, and JAK inhibitors. The specific drugs assessed by researchers included:
- Humira (adalimumab; Abbvie)
- Cimzia (certolizumab pegol; UCB)
- Enbrel (etanercept; Amgen)
- Simponi and Simponi Aria (golimumab; Janssen)
- Remicade (infliximab; Janssen)
- Rituxan (rituximab;Genentech)
- Orencia (abatacept; BMS)
- Kevzara (sarilumab; Sanofi and Regeneron—currently under FDA review)
- Actemra (tocilizumab;Genentech)
The analysis found that all of the TIMs reviewed by researchers represented substantial health benefit compared to conventional DMARDs, and most patients treated with TIMs showed significant improvements. According to the results of head-to-head comparisons, some of the TIMs showed comparable or better net health benefits for several agents.
In order to better reflect real-world practice in the report, ICER applied an average discount to the wholesale acquisition cost for each drug class. This allowed each drug to arrive at an estimated net price for use in the cost-effectiveness analysis.
According to the findings, ICER concluded that all of the agents exceeded the commonly cited cost-effectiveness thresholds as compared to use of conventional DMARDs alone. The report found that costs ranged from $168,660 (tocilizumab, subcutaneous injection) to $271,749 (tofacitinib) per QALY gained. Additionally, they found that compared to Humira, eight TIMs were more cost-effective and less costly.
“These results raise important questions about existing pricing and coverage policies,” Steven D Pearson, MD, MSc, ICER president said in a press release. “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 RA.”
Also included in the report was value-based price benchmarks that help to identify prices where the cost of the drugs align with the benefit they bring to patients. Researchers determined that TIMs would need to be discounted anywhere from 29% to 69% in order to meet the accepted cost-effectiveness pricing threshold.
—Julie Gould (Mazurkiewicz)