How ICER and cost-effective analyses influence the pricing of drugs such as icosapent ethyl.
Maybe i can talk now a little bit about i sir but not be eyesore anyway the dr. ruston is referring to it but rather the institute for clinical and economic review which also has the acronym icer which i must say does confuse some people that are fully in the field it is there is no two different uses of the word at anyway to be folks from eyesore recently put
Out a report on cost-effectiveness of additive cardiovascular disease that are faced in particular they cover two relatively recent advances rivaroxaban which at the so called vascular dose was found to be highly effective in the compass trial and a coast of pentothal due to the reduce of trial and maybe i can just turn to dr. breast first of all to just say you
Know what he thought about the report’s findings did you agree with it and they came both of those drugs cost-effective and then just your further thoughts on whether we should implement those findings absolutely so the icer group is a high quality group and i agree with their findings in general and just to review their findings the iso report and i’m gonna focus
On that coast bit ethyl here was published last october and used a standard literature based markov model which means they use data from published sources and didn’t have access to individual participant level data from any of the trials to estimate the cost effectiveness of ikos open ethyl versus placebo in reducing eligible patients over a lifetime from a payer
Or health sector perspective and the model applied treatment effects from reduce it and healthcare and medications cost data from national and commonly used sources and the top line result as dr. bob mentioned was assuming a ikos open methyl cost of about one hundred and thirty three dollars a month which reflects a net pricing cost or a reduced cost which is an
Estimate of what they believe pharmacies and health systems are paying for the product the model predict that ikos been ethel compared to standard care cost approximately 18,000 per quali gained than placebo and what this means is that use of eiko spinel in a reduce it eligible population was cost-effective and well below common us willingness to pay thresholds and
Would be considered to be high-value according to the american heart association in american college of cardiology and therefore the higher medication costs from my co spend ethel were balanced by health gains from prevented cardiovascular disease events yeah i think that’s a really nice way of explaining it to the audience and and you know increasingly i believe
Physicians i have to keep on top of these sorts of evaluations of cost-effectiveness no question about that you know maybe i can also then just ask you again dr. breath to talk a little bit about some of the reduce it cost-effectiveness analysis you you know colleagues have played a pivotal role in performing those but maybe for the audience you can just give them
A recap of what was presented by dr. bill weintraub like the american heart association it is a late-breaking clinical trial in 2019 sure thing dr. bhatt it’s been a pleasure for me to connect with you and dr. wine triple on this analysis and what was presented at the american heart association sessions last november was a preliminary report of a project that as
Opposed to the iso report is using actual patient level data from the reduce and trial and we applied a combination alongside the trial and simulation based cost-effectiveness approaches to estimate the lifetime cost effectiveness of my kosovan ethel versus placebo in reduce at eligible patients and the patient level component i think is important because it allows
For us to in a more granular way and more fully capture the effects of ico spinel during the trial on critical costly events like revascularisation x’ as mentioned before by dr. boot off and the top line results from this analysis were that ico spent ethyl at a discounted price at a hundred and twenty-five dollars per month which is very similar to the cost input
Used in the iso report was cost-saving in almost all scenarios and regardless if treatment effects persisted or decayed in the post trial period and what this means what cost savings means is that ico spent ethyl offers better health at a lower cost overall when used in reduce it eligible population over a lifetime and this is due to the cost savings from averted
Events offsetting completely the cost of the medication you know that’s a very very nice summary and how would you say this compares to say the cost-effectiveness analysis for the pcsk9 inhibitors yeah so that’s an important comparison i might start with the fact that dr. bots cost savings in cardiovascular disease prevention whether primary or secondary is very
Rare the only two interventions that i’m aware of in cardiovascular disease research that are cost savings are treating hypertension compared to not treating among high risk people and statins for second and low-cost generic stands for secondary prevention statins for primary prevention among those with a pooled cohort a scv 10-year risk of greater than 7.5 cost
About $40,000 per quality just to give you some context and in terms of the pcsk9 inhibitor analyses i’ll refer to one of the odyssey outcomes trial that that that you led so please correct me if i’m wrong on anything i mentioned but a similar alongside the trial cost-effectiveness analysis of that trial found that a larocca map among patients with a recent acute
Coronary syndrome with an ldl above 70 on good doses of a torta statin or versova found that overall a larocca map the cost about 100 thousand dollars per quali overall in the trial but among those with a ldl cholesterol at baseline above 100 a larocca mab was much higher value and i believe with the icer around 40,000 per quali so when comparing i co spent ethel
A branded medication to another brand of medication of pcsk9 inhibitor the value assessment looks very different i co spent ethel it looks much more favorable in a fact in a value stay standpoint from the cost-effectiveness analysis we have right now
Transcribed from video
Cost-Effectiveness Data and Pricing of Icosapent Ethyl By AJMCtv