ICER criticizes cost of 8 targeted immune modulators for UC, recommending some deep discounts
While 8 targeted immune modulators (TIMs) on the market for ulcerative colitis have proved beneficial to patients, nonprofit cost-effectiveness watchdog ICER called the drugs unreasonably expensive, recommending some deep discounts to match the drugs with their actual value.
In a report released Friday, ICER assessed the cost vs. clinical benefit of market leader Humira — for which AbbVie has faced price gouging accusations — as well as Janssen’s Simponi, Stelara and Remicade, Merck’s Renflexis, Pfizer’s Inflectra and Xeljanz, and Takeda’s Entyvio.
” … The costs of these drugs is substantial, especially over time, and the prices for all of these therapies remain above reasonable levels for the benefits patients receive,” ICER’s CSO Pamela Bradt said in a statement.
While Remicade’s prices have been reduced in recent years, likely as a result of competition with biosimilars, Bradt suggested that pricing for all eight TIMs need to come down further “to hit that sweet spot at which we are richly rewarding the benefits for patients and encouraging further innovation without adversely contributing to greater harms through the negative effects of rising health care costs for patients and families.”
UC, a chronic inflammatory bowel disease, leads to long-lasting inflammation and ulcers in the digestive tract, and is characterized by frequent diarrhea, abdominal or rectal pain, weight loss and fatigue. ICER estimates that on average, UC patients shell out between $2,000 to $4,000 each year, out-of-pocket. “Costs are especially onerous for patients without insurance or those who are unable to work due to their disease,” the report states.
In a study pitting Takeda’s Entyvio against Humira, ICER researchers found that Entyvio achieved greater rates of response and remission in biologic-naïve and biologic-experienced patients. The other TIMs were at least comparable to Humira, with “no clear differences among them,” according to the report.
The institute came up with a health benefit price benchmark (HBPB) — a price range indicating the highest price a manufacturer should charge for a treatment, based on the amount of improvement in overall health to patients — for each of the eight TIMs. Humira, which can cost more than $72,000 a year, would need to be discounted by 90% to 92% to meet ICER’s suggested range ($6,000 to $7,000 per year).
Simponi’s wholesale acquisition cost would need to be slashed by 90% to meet the HBPB of $6,300 to $7,600 per year. Remicade would need to come down by 61% to 68%; Inflectra by 52% to 61%; Renflexis by 40% to 51%; Stelara by 89% to 95%; and Entyvio by 73% to 80%, according to ICER.
At the start of the year, AbbVie upped Humira’s price by about 7%. And in 2017 and 2018, the biotech hiked the wholesale acquisition cost by more than 19%, according to ICER. Lawmakers, including Sen. Elizabeth Warren, have accused the company of price gouging.
“Humira is used by millions of patients around the world to treat diseases like arthritis, psoriasis, and Crohn’s disease,” Warren tweeted last year. “But its manufacturer, AbbVie, doubled its price — and used blatantly anti-competitive behavior to prevent a competitor from entering the market.”
Unions and health care purchasers have filed class-action lawsuits alleging AbbVie used a “patent thicket” to create an illegal monopoly, and that AbbVie colluded with the biosimilar competitors to divide the market. Humira raked in $14.9 billion in net sales last year, according to the AJMC’s Center for Biosimilars.
ICER will review its report on TIMs for UC in a virtual public California Technology Assessment Forum on Sept 24.