Value Viewpoint: November 8, 2024

New research published in Health Affairs (paywalled) this week compares incremental QALY gains, incremental costs, and incremental cost-effectiveness ratios (ICERs) of small-molecule drugs and biologics approved by the FDA from 1999 to 2018. From their analysis, study authors found that small-molecule drugs had:

• similar incremental QALY gains as biologics,
• lower incremental costs, and
• more favorable cost-effectiveness ratios.

These findings have important implications given the context of the Inflation Reduction Act, which creates incentives to steer investment away from small-molecule drugs and toward biologics. About this, study authors conclude,

“Our findings suggest that differential timelines for price negotiation could have detrimental effects, potentially leading to fewer new small-molecule drugs. This is concerning, as small-molecule drugs generally have more favorable cost-effectiveness profiles than biologics.”

The November 2024 issue of Value in Health has a few studies of interest, two of which I’ve covered previously:

• Assessing the Health and Welfare Benefits of Interventions Using the Wider Societal Impacts Framework seeks to develop a wider societal impacts (WSI) framework which considers how changes in health alter a person’s net contribution to society for 199 chronic conditions in the UK.
• Informing the United States Medicare Drug Price Negotiation for Apixaban and Rivaroxaban: Methodological Considerations for Value Assessments Many Years After Launch (paywalled) (See the August 9 Value Viewpoint for my previous write-up)
• Development of a Prioritization Framework to Aid Healthcare Funding Decision Making in Health Technology Assessment in Australia: Application of Multicriteria Decision Analysis (See the August 9 Value Viewpoint for my previous write-up)

My latest column with The Evidence Base? recapping the September/October developments in the value space is up. Check it out for an overview of what I expected, what surprised me, and what it means for the field of value assessment.

??? Eye on ICER

Calendar of ICER’s upcoming reports & meetings:

Reports:

- 12/9/24: Acute Pain — Draft Evidence Report

- 12/12/24: Unsupported Price Increases Occurring in 2023 — Policy White Paper

- 12/16/24: Epstein-Barr Virus Positive Post-Transplant Lymphoproliferative Disease — Final Evidence Report

- 12/19/24: Fair Access: Coverage Policies in 2024 — Policy White Paper

- 2/5/25: Acute Pain — Revised Evidence Report

- 2/6/25: Retinitis Pigmentosa — Draft Evidence Report

- 3/4/25: Special Assessment to Inform CMS Drug Price Negotiation: Breo Ellipta and Trelegy Ellipta — Final Report

- 3/26/25: Retinitis Pigmentosa — Revised Evidence Report

Meetings:

- 11/14/24: Epstein-Barr Virus Positive Post-Transplant Lymphoproliferative Disease — Public Meeting (New England CEPAC)

- 2/28/25: Acute Pain — Public Meeting (Midwest CEPAC)

- 4/11/25: Retinitis Pigmentosa – Public Meeting (New England CEPAC)