KEY TAKEAWAY: A study in JAMA found “a Markov cohort state-transition model determined that adding evolocumab at current list price to patients receiving standard background therapy was estimated to cost $268 637 per quality-adjusted life-year gained. Sensitivity and scenario analyses demonstrated incremental cost-effectiveness ratios ranging from $100 193 to $488 642 per quality-adjusted life-year.” Will this be enough to sway insurers to say “ok”?
Conclusions and Relevance At its current list price of $14 523, the addition of evolocumab to standard background therapy in patients with atherosclerotic cardiovascular disease exceeds generally accepted cost-effectiveness thresholds. To achieve an ICER of $150 000 per QALY, the annual net price would need to be substantially lower ($9669 for US clinical practice and $6780 for trial participants), or a higher-risk population would need to be treated.
1ne: This data is based on a model, simulation, and is not real world data as the drug is too new.
2wo: Expect insurers to continue to “push back against this drug because of its price as compared to other treatments.
3hree: Real world studies, using patient outcomes vs costs, are going to become the norm. While some patients might fight for their insurers to cover expensive drugs higher co-pays could continue to force patients to chose low cost alternatives. For oncology, however, this may not be the case as insurers are reluctant to deny cancer patients potential life saving drugs even though they may only provide limited effectiveness.