OBJECTIVES: To analyze published cost-effectiveness analyses (CEAs) for the 15 drugs selected for the Initial Price Applicability Year 2027 by the Centers for Medicare and Medicaid Services.
METHODS: We identified CEAs for the 15 drugs from the Tufts Cost-Effectiveness Analysis Registry. For each drug, we included all base-case incremental cost-effectiveness ratios (ICERs) and calculated median and interquartile ranges for positive ICERs for each drug indication. We also performed the analyses on CEAs conducted in the United States, which used a lifetime horizon, or were industry sponsored. We present all costs in 2022 US dollars.
RESULTS: A total of 20 drug-indications were included in the analysis. Most studies used a nonsocietal perspective and were industry sponsored. Median positive ICERs ranged from $1800 (linagliptin) to $640 000 (acalabrutinib) with 6 drug indications having a median ICER less than $50 000 and 10 more than $100 000. Among the 13 drug indications with US-based CEAs, 11 had a median ICER near or more than $100 000. Among CEAs with a lifetime horizon, 7 drug indications had a median ICER less than $50 000, and 5 more than $100 000. CEAs sponsored by industry had median ICERs more than $100 000 for 5 drug indications. The median ICERs differed considerably between the 2 covered indications for semaglutide, linaclotide, and rifaximin.
CONCLUSIONS: As Centers for Medicare and Medicaid Services continues to implement its drug price negotiation program, promoting greater transparency and consistency in how value is defined and applied to pricing decisions will be essential. CEA can serve as an important source of evidence, ensuring that negotiated prices more closely reflect the benefits drugs provide.
