WHAT IS THE FUTURE OF VALUE-BASED CARE?

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February 8, 2022

Charted: How cost-effective are 4 major Covid-19 treatments?

Daily Briefing

    According to a draft report from the Institute for Clinical and Economic Review (ICER), the cost of currently available Covid-19 outpatient treatments, including monoclonal antibodies and antiviral pills, are "reasonably aligned" with their benefits for patients.

    Covid-19 antivirals are here: Here's how to make them 'game changers'

    Report details and findings

    For the report, ICER examined four Covid-19 treatments: GlaxoSmithKline (GSK) and Vir's monoclonal antibody sotrovimab, Pfizer's antiviral pill Paxlovid, Merck's antiviral pill molnupiravir, and the generic drug fluvoxamine. All analyzed treatments have been authorized for Covid-19 treatment by FDA except for fluvoxamine, although it can be prescribed off-label to treat the disease.

    To estimate the cost-effectiveness of each treatment, ICER used four measures:

    • Cost per quality-adjusted life year (QALY) gained
    • Cost per life year gained
    • Cost per equal-value life year gained
    • Cost per in-person hospitalization averted

    ICER considered all the treatments to be cost-effective since they cost under $100,000 per QALY. Sotrovimab, molnupiravir, Paxlovid, and fluvoxamine cost $2,100, $707, $529, and $12, respectively, per treatment.

    When balancing these treatment costs and QALY, ICER found that fluvoxamine offered the best value for patients, followed by Paxlovid, molnupiravir, and sotrovimab. However, fluvoxamine reduced the relative risk of Covid-19-associated acute care when compared with placebo by only 32%, while sotrovimab, molnupiravir, and Paxlovid reduced the relative risk of hospitalization or death by 79%, 30%, and 88%, respectively.

    "These treatments also have important potential benefits that cannot be fully captured or evaluated in the economic model, including the potential for preventing further spread of SARS-CoV-2 and improving hospital capacity," ICER wrote. "In addition, effective outpatient treatments may help provide psychological reassurance allowing for broader opening of schools and workplaces, and help address the disparate burden of the pandemic in disadvantaged communities."

    Comments

    According to Steve Pearson, ICER founder and president, the report's initial findings are unique since ICER typically finds that drugs are reasonably priced only around 25% of the time.

    "The unique feature here is these prices are the product of price negotiation, at least for two of them [Paxlovid and molnupiravir]," Pearson said, noting that this may be the first time ICER has evaluated drugs whose prices were negotiated by the federal government.

    However, Pearson added that ICER's analysis is still preliminary and could change if the risk of hospitalization from omicron or a future variant proves to be lower or if the treatments were used in lower-risk populations, which could significantly reduce their cost effectiveness.

    Currently, ICER is accepting public comments on its draft report through March 3 and is expected to issue an updated report in late March, Reuters reports. (Brennan, Endpoints News, 2/3; Adams, Becker's Hospital Review, 2/4; Beasley, Reuters, 2/3)

     

    Advisory Board's take

    The definition of 'value' is expanding—and it's a good thing

    Pamela DivackBy Pamela Divack, consultant 

    How should we define and measure medical value?

    Over the last several years, my team and I have been tracking this exact question. After reading the preliminary analysis and related commentary from the ICER report, I'm excited to see an expansion in the way health care leaders—and society overall—defines the "value" of medications. Assessment now goes beyond the traditional static approach of looking merely at safety, efficacy, and upfront costs.  

    Specifically, ICER's comments about how Covid-19 treatments can benefit society illuminate how components of medical "value" are not always quantifiable in an economic or clinical analysis. While such debates about "value" have existed for years, society saw this concept unfold firsthand with Covid-19 vaccines and the critical role they played in reopening workplaces, schools, and borders. ICER's report highlights that this is also true for Covid-19 treatments. Not only can Covid-19 treatments generate clinical value by reducing the risk of hospitalizations and deaths, but they can also create societal value through 'psychological reassurance' and an expanded accessibility of care, which has potential to improve health care disparities. However, to actually capture such societal benefits of Covid-19 treatments, health care leaders need to take active steps to make Covid-19 treatments available to patients and overcome critical barriers to access, equity, and communication.

    Assessing value beyond Covid-19

    This sentiment is applicable beyond Covid-19 related vaccines and treatments. Advisory Board's Cross-Industry Research on medical value has illuminated just how complex the conversation around "medical value" is—especially as one starts to explore underlying tensions in how value is defined, measured, and assessed at both the population and individual patient level. For example, assessing the "value" of a drug or medical product can also involve looking at the patient experience with a course of treatment, or how a product impacts total cost of care. ICER has already taken steps to incorporate such perspectives and consideration in its reports, which is evident in this latest analysis.

    What this means moving forward

    In the past, value assessments have been relatively static and based on a limited amount of data from randomized control trials (RCT) and fixed prices. Stakeholders, including ICER, have already started to incorporate more real-world data and patient perspectives into "value" analysis. The "value" of a treatment can evolve over time, depending on whether new evidence or information emerges that can impact when, how, and for whom a treatment is used. Moving forward, it's possible that stakeholders take a more dynamic approach to value assessment, updating assessments, prices, and clinical guidelines in real-time based on emerging real-world data and evidence.

    Moving forward, there are multiple questions I’ll be closely monitoring:

    • How will the final report change with new evidence and information about the treatments (and the pandemic overall)?
    • In what other ways has Covid-19 catalyzed conversations about broadening the definition of medical "value" overall?
    • Practically, what will it mean for ICER and other health care stakeholders to acknowledge the fact that value changes over time? How will the cadence of value assessments evolve, and what will trigger further assessments?
    • How will ICER factor in potential treatment access and coverage restrictions into its analysis?
    • If the results of the final report are vastly different than those from the preliminary report, how will life sciences manufacturers respond?

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