IHE participates at the conference with a poster presentation on the importance of considering price metrics and market dynamics in US economic evaluation, using the case of SGLT-2 inhibitors in the treatment of T2D. Michael Willis from IHE will also moderate a workshop, “Addressing Heterogeneity in Comparative Economic Analysis in the Decentralized US Setting: Are We Doing Enough to Support Patient-Centered Decision-Making”.
The Importance of Considering Price Metrics and Market Dynamics in US Economic Evaluations: The Case of SGLT-2 Inhibitors in the Treatment of Type 2 Diabetes (T2D)
Name of authors: Willis Michael, Neslusan Cheryl and Nilsson Andreas
Name of Presenter: Neslusan Chery
In the US T2D market, prices reflect both branded and generic competition, within and across classes. Despite recommendations, comparative economic analyses usually hold relative prices constant and, equally unrealistic, often use list prices. Even the few analyses that use prices net of manufacturer rebates understate opportunity costs by excluding time-varying intermediary margins. We illustrate the implications of these choices by simulating canagliflozin 300mg vs. sitagliptin 100mg in treating T2D.
Health outcomes and costs associated with these treatment strategies were simulated starting at canagliflozin launch in 2014. List prices, net prices, and systemwide net expenditures (SNE) (i.e., the sum of intermediary margins and net price) were sourced from SSR Health data. Results using fixed 2014 prices were compared to results based on actual prices through 2021 and to results based on forecasted prices over 25 years using T2D market price trend data available in 2014.
Canagliflozin was associated with fewer micro- and macrovascular complications, resulting in sizable cost offsets and greater longevity. Replacing fixed list prices with actual time-varying net prices reduced estimated canagliflozin and sitagliptin costs by 40% and 60%, respectively. Using a fixed 2014 net prices versus actual time-varying net prices overestimated the difference in drug cost between canagliflozin and sitagliptin by 37%. Net total cost savings with canagliflozin were 11 times higher with time-varying actual SNE versus time-varying actual net prices. The 25-year results were more variable, driven by additional uncertainty introduced by modeling future prices.
Results illustrate the sensitivity of comparative economic analysis to different price metrics and assumptions about future prices, as well as the importance of accounting for rebates paid to insurers and PBMs. Like other time-varying parameters routinely projected into the future, prices that reflect the current market and anticipated market dynamics should be used as per guidelines.
Workshop May 9
Addressing Heterogeneity in Comparative Economic Analysis in the Decentralized US Setting: Are We Doing Enough to Support Patient-Centered Medical Decision-Making?
Discussion Leader: Michael Willis, PhD, The Swedish Institute for Health Economics, Lund, Sweden
Discussants: Tara Lavelle, PhD, Tufts Medical Center, Boston, MA, USA; Richard Chapman, PhD, MS, Innovation and Value Initiative, Alexandria, VA, USA; Kimberly Westrich, MA, Xcenda, Herndon, VA, USA
Despite evidence that treatment value often varies across patient subgroups, coverage decisions in the US are usually based on evidence aggregated at the population level. Thus, patients diverging from the average risk “being denied for being different,” as cautioned by the National Pharmaceutical Council, with suboptimal patient and economic outcomes. The purpose of this workshop is to promote cross-stakeholder awareness of the implications of unaddressed heterogeneity in comparative economic analysis and discuss how best to promote evidence generation capable of supporting patient-centered decision-making.
The workshop will begin with an overview of heterogeneity in comparative economic analyses, including a discussion of important sources relevant to the decentralized US setting (e.g., socioeconomic, geographic, insurance, and provider variability). Methods to address heterogeneity and implementation challenges will be outlined (Willis, 10 minutes). Next, the consideration of heterogeneity in the US cost-effectiveness literature will be discussed, leveraging results from two Tufts Cost-Effectiveness Analysis (CEA) Registry samples. Good practices and opportunities for improvement will be illustrated via examples from the literature (Lavelle & Willis, 10 minutes). The next discussant will highlight underappreciated and under-studied sources of heterogeneity that may be particularly important in the decentralized US setting (Chapman, 10 minutes). The last discussant will present the payer perspective, including issues with implementation in health benefit design, such as resource constraints, institutional barriers, and equity concerns (Westrich, 10 minutes). An interactive case study that includes various sources of heterogeneity will be used to facilitate audience participation. This hands-on learning exercise will highlight the importance of considering all relevant sources of heterogeneity when tailoring analyses to decision problems. Different stakeholder viewpoints, evidence requirements, and barriers to implementation will be discussed (All, 20 minutes). This workshop will be valuable to researchers, payers, patient representatives, and manufacturers interested in ensuring that comparative economic analysis supports patient-centric decision-making.
Conference: ISPOR (International Society for Pharmaeconomics and Outcomes Research) Annual Meeting
Place: Boston, MA, USA
Date: May 7-10, 2023