0920 GMT January 19, 2020
Boston-based Institute for Clinical and Economic Review (ICER), whose assessments of the value of new medicines are increasingly influential in US drug price negotiations, calculated a measure known as ‘quality-adjusted life year’ to evaluate the drugs, Reuters reported.
The findings may be revised based on comments from the drugmakers, health plans and patients before a final assessment in late February.
While there are questions about the long-term effectiveness of the treatments, both provide substantial clinical benefit, ICER said.
Spinal muscular atrophy (SMA) is a rare disease that can lead to paralysis, breathing difficulty and death. Spinraza, introduced two years ago, is the only US-approved treatment for the condition and one of the most expensive drugs on the market, costing $750,000 for the first year of use and $375,000 annually thereafter. It has been shown to slow progression of the disease for some patients but is not a cure.
ICER’s preliminary estimate is that Spinraza represents a cost of $728,000 per quality-adjusted life years (QALY) , or years of healthy or near healthy life, for patients who are diagnosed before they exhibit symptoms.
“That is expensive by the way most people value things,” said ICER’s chief medical officer, Dr. David Rind.
Novartis aims to provide a cure with its gene therapy, which is to be called Zolgensma and is expected to receive US approval in the first half of 2019. The drugmaker said the therapy’s price will eventually be determined in negotiations with health plans but believes that it would be cost-effective at $4 million to $5 million as a one-time treatment.
ICER said it used a much lower benchmark— $2 million — as an estimated price for the gene therapy. On that basis, when used in patients with symptomatic Type I SMA, it said the Novartis therapy represents a cost of $240,000 per quality- adjusted life year.
Generally, treatments that cost between $100,000 to $150,000 per QALY are considered a good value, though that can stretch higher for rare diseases, Rind said.
Novartis spokesman Eric Althoff said Novartis would like the drugs to be compared against an ultra-rare threshold of $500,000 per QALY and against Spinraza.
“While a range of QALY thresholds were used, we believe cost-effectiveness assessments in SMA should be compared to currently available, chronic therapy and be assessed at the ultra-rare disease QALY threshold,” he said.