- The Institute for Clinical and Economic Review, commonly known as ICER, finalized its report this week that found asthma biologics are by and large overpriced.
- The report focused on five treatments, and found all would need discounts of at least 60% to achieve minimum cost-effectiveness standard of $150,000 per quality adjusted life year, or QALY. The bigger offender in ICER's eyes is Teva's Cinqair, which holds an annual price of $31,637 and would require a 67% discount.
- While ICER findings are not enforceable, they have gained increasing influence and clout — alongside criticism — as the independent nonprofit has developed a reputation as a leading pricing watchdog in the U.S.
This latest ICER report analyzed Sanofi and Regeneron's Dupixent (dupilumab), Genentech and Novartis' Xolair (omalizumab), GlaxoSmithKline's Nucala (mepolizumab), Teva's Cinqair (reslizumab) and AstraZeneca's Fasenra (benralizumab).
These drugs all carry annual wholesale acquisition costs (WACs) of between $30,000 and $40,000. The report offset the prices of all of the participants against their effectiveness in this small yet crowded market, and none of the products came out well.
"All five biologics modestly reduce asthma exacerbations and improve daily quality of life," ICER's chief medical officer David Rind said in a Nov. 13 statement. "However, the treatments’ net prices appear to be far out of alignment with these incremental clinical benefits, and the entire therapy class would need to see price discounts of at least 50% to reach commonly cited thresholds for cost-effectiveness."
|Drug||Annual price*||$150,000 per QALY price||% discount to meet ICER range|
*As determined by ICER
The draft report was initially released Sept 24. The necessary discounts were raised in the final version, as many of the WACs have increased. In the draft report, for the $100,000 QALY threshold, the largest discount requested was for Dupixent — at 68% for its $36,000 WAC.
ICER reports are carrying ever greater weight as of late. Pharmaceutical benefit manager CVS Caremark announced in August, for example, that it would adopt ICER's value-based drug pricing system and exclude some higher-priced drugs.
An increase in funding last year of $14 million will increase ICER's scope to assessing all newly approved drugs, which may not please manufacturers but could sit well with payers.