Impact of using real-world outcomes versus clinical evidence and list prices on value assessments

Abstract

Background: To assess value, industry organizations often use list or net prices to calculate average prices per patient or price per QALY. However, this methodology requires numerous assumptions which need to be validated and can be challenging to ascertain. A better approach is to use fully adjudicated net prices and real-world clinical outcomes data for value assessments. Aims: We sought to demonstrate the impact on value analyses of using list vs. net prices. Methods: Using the IBM Access and Value Connect solution, patients in the IBM MarketScan Commercial Database between 1 October 2016 and 30 September 2017 with a psoriasis diagnosis were identified. To demonstrate an example of impact on value assessments, we calculated the mean per-patient-per-month (PPPM) cost associated with apremilast and compared that to the net price calculation reported in the 2018 Plaque Psoriasis Condition Update by the Institute for Clinical and Economic Review (ICER), based on per-unit dosing and discount assumptions. Results: We identified 4169 patients with a psoriasis diagnosis during the study period. The adjudicated claims PPPM cost for US health plans was $20,821 with a mean duration of exposure to apremilast of 243 days and including concomitant psoriasis medications. This is approximately $10,000 less than the net price presented in the 2018 ICER report ($30,807 Year 1, $31,018 Year 2) . Numerous additional differences between the real-world performance data and ICER evidence report were identified. Conclusions: Our analysis found that using a fully adjudicated net price: (1) allowed direct comparison of prices amongst therapies quickly and easily; and (2) facilitated a more accurate reflection of price versus value when used alongside analysis of the real-world clinical outcomes data. We recommend that net prices and real-world data be used for value assessments whenever possible. Value assessment organizations should incorporate the numerous data sets and tools available to improve transparency, accuracy and ease of analysis.