While the U.S. remains far from having an officially-sanctioned health economics and outcomes research agency like the National Institute for Health and Care Excellence (NICE) in the U.K. (or any number of similar agencies authorized in other countries over the past decade), some high-visibility (read, pricey) drug categories are receiving similar attention from prominent physician groups.
For example, a joint panel of the American Association for the Study of Liver Diseases and Infectious Diseases Society of America has recommended that new hepatitis-C drugs from Gilead Sciences and AbbVie are cost-effective for certain early-stage patients who are currently denied coverage by most providers. But the group based its findings on an important caveat: the “cost” in “cost-effective” is based on prices 40 to 60 percent below current levels.
That comes on the heels of a draft framework issued by a task force from the American Society of Clinical Oncologists (ASCO) that proposes a methodology for determining the cost-benefit ratio of cancer treatments. As with the hep-C drugs, new cancer therapies, which can cost from $10,000 to $30,000 per month, have spurred the oncologists into action.
The task force has already used the framework to analyze metastatic lung cancer, advanced multiple myeloma, metastatic prostate cancer, and adjuvant therapy for HER2-positive breast cancer. While some treatments scored higher than their older counterparts, others showed negligible improvement, a finding that makes their higher price tags harder to justify in the eyes of payers.
As we discussed here recently, last-year’s hefty growth rates may be somewhat short-lived. While it is too early to determine the accuracy of that prediction, there appears to a gathering of forces that will exert pressure to keep prices down. Most notably, due to mergers announced in the last few months, pharma will face the challenge of increased negotiating leverage from ever-larger insurance companies. Now, physician groups, who have enormous credibility and influence with the public, media, and policy makers, are stepping into the health economics debate in a more organized fashion.