- The independent group Institute for Clinical and Economic Review estimated AbbVie's new rheumatoid arthritis drug Rinvoq, when compared to Humira, costs about $92,000 per "quality adjusted life year," or QALY, a measurement of cost-effectiveness.
- The report issued today replaces one that ICER pulled due to a "need to re-evaluate some of the assumptions and calculations" based on real-world treatment patterns. The earlier report estimated a marginal cost per QALY of $482,000.
- Nonetheless, ICER said Rinvoq "provided marginal clinical benefit over [Humira] at higher costs" that could call into question its cost effectiveness.
ICER's0 report sought to evaluate three drugs in the JAK inhibitor class, which in rheumatoid arthritis was led by Pfizer's Xeljanz (tofacitinib) in 2012. Eli Lilly's Olumiant (baricitinib) and AbbVie's Rinvoq (upadicitinib) have since launched.
However, the report focused on the use of JAK inhibitors in previously untreated patients, which entailed a direct comparison with AbbVie's older drug Humira (adalimumab). Only Rinvoq had data that was consistent enough to make such a comparison.
The first iteration of the report assumed patients whose diseased progressed after first-line treatment went on to receive palliative care rather than to other targeted immune modulators like Humira, which affected the calculations. ICER said the revised version of the report may better reflect how patients cycle through therapies.
ICER calculated Rinvoq plus background drugs yielded a slightly higher QALY compared to Humira, resulting in a cost per QALY gained of $92,000.
The group concluded "these outcomes translate into cost-effectiveness estimates that fall under the upper end of the commonly cited cost-utility threshold of $150,000 per QALY."
The report also made an indirect comparison between Xeljanz and Humira indicating that "a price much higher than [Humira] may not be justified." It estimated a $36,000 net price for Xeljanz.
The report is open for public comment until Nov. 8. The California Technology Assessment Forum, one of ICER's consulting committees, will debate and vote on the report Dec. 9.