ICER questions cost effectiveness of multiple myeloma therapies
- According to a report from the Institute for Clinical and Economic Review (ICER), some of the newer multiple myeloma (MM) drugs, including Amgen's Kyprolis, have cost-effectiveness ratios above ICER's accepted threshold.
- In their analysis, ICER said that treatment with Kyprolis, carfilzomib, Bristol-Myer Squibb and AbbVie's Empliciti, elotuzumab, and Takeda's Ninlaro in combination with Revlimid and dexamethasone for second- and third-line treatment of MM offer "moderate certainty" of an incremental health benefit versus standard therapy, yet exceed the $50,000 to $150,000 per QALY — ICER's target cost-effectiveness ratio.
- Amgen pushed back against the analysis. According to the company's model, the incremental cost per QALY was below the $150,000 to $300,000 per QALY level, which is cited as reasonable a reasonable cost-effectiveness ratio for cancer treatment in the U.S.
Kyprolis was not the only drug that exceeded ICER's cost-effectiveness threshold. Estimated cost-effectiveness ratios per QALY for other drugs included in the analysis were $255,498 for Empliciti and $390,639 for Ninlaro as second-line therapy. As third-line therapy, the drugs' cost-effectiveness ratios were $312,840 per QALY for Kyprolis, $289,425 for Empliciti and $435,855 for Ninlaro.
Robert Goldberg, vice president and co-founder of the Center for Medicine in the Public Interest, disagrees with the ICER framework in particular and the use of what he views as arbitrary benchmarking.
"Health is an investment. Like other investments, the up-front costs are often high, but the returns accrue over a lifetime. Drugs that are hugely effective and that treat broad swaths of the population would by any other metric be considered socially valuable," he told BioPharma Dive.
"However, the value frameworks that rely on assessing overall budget impacts as a determining factor of value would paradoxically favor drugs that have limited scope or are or less frequently prescribed, possibly due to lower quality," he said. "Certain frameworks require that future spending on medical innovations be capped at the historical share that medical innovations have comprised in overall health care spending, which is wholly inconsistent with rewarding value. If technologies become more effective over time, their share of overall health care spending should increase."
While it is unclear precisely what impact ICER's computations will have on reimbursement rates for Kyprolis and other MM drugs, this data could be used as a basis for refusing coverage. Comments on the report are due April 21 and a public meeting will be held May 26 by ICER's Midwest Comparative Effectiveness Public Advisory Council.