Photo Credit: Vitalii Petrushenko

The following is a summary of “Use of Efficiency Frontiers to Align Prices and Clinical Benefits of Biologic Therapies for Plaque Psoriasis,” published in the February 2024 issue of Dermatology by Egilman, et al.

The US currently lacks a systematic method for ensuring that drug prices reflect their clinical benefits, and traditional cost-effectiveness analysis (CEA) faces political challenges. However, a novel approach, the efficiency frontier (EF) method, could potentially provide a solution to this issue.

For a study, researchers sought to evaluate how the EF approach could harmonize prices and clinical benefits of biologic medications for plaque psoriasis. It also sought to estimate potential price reductions in the US compared to four peer countries: Australia, Canada, France, and Germany.

The health economic evaluation was conducted using the EF method to compare the prices and clinical benefits of 11 biologics and 2 biosimilars for plaque psoriasis across the US, Australia, Canada, France, and Germany. The data collection period was from February to March 2023, and the analysis was carried out from March to June 2023.

Key outcome measures included constructing EFs based on each biologic’s efficacy, measured by the Psoriasis Area and Severity Index (PASI) 90 response rate and annual treatment cost as of January 2023; US costs were adjusted for estimated manufacturer rebates. Prices derived from the EF were then compared with traditional CEA-based prices calculated by the Institute for Clinical and Economic Review, using a threshold of $150,000 per quality-adjusted life-year gained.

Among the 13 biologics analyzed, PASI 90 response rates varied widely, ranging from 17.9% for etanercept to 71.6% for risankizumab. The range of US net annual treatment costs was also substantial, from $1664 for infliximab-dyyb to $79,277 for risankizumab. Comparatively, the median (IQR) net annual treatment cost in the US was higher at $34,965 ($20,493-$48,942) than the pre-rebate costs in Australia ($9179 [$6691-$12,688]), Canada ($15,556 [$13,017-$16,112]), France ($9478 [$6637-$11,678]), and Germany ($13,829 [$13,231-$15,837]). The US efficiency frontier (EF) comprised infliximab-dyyb (PASI 90: 57.4%; annual cost: $1664), ixekizumab (PASI 90: 70.8%; annual cost: $33,004), and risankizumab (PASI 90: 71.6%; annual cost: $79,277). A median (IQR) reduction of 71% (31%-95%) would be necessary to align US prices for psoriasis biologics with those estimated using the EF. Conversely, the reductions required in Canada, Australia, France, and Germany were smaller, at 41% (6%-57%), 36% (0%-65%), 19% (0%-67%), and 11% (8%-26%), respectively. Except risankizumab, EF-based prices were lower than those derived from traditional cost-effectiveness analysis (CEA)

In conclusion, the adoption of the EF approach to negotiate prices for plaque psoriasis biologics could have tangible benefits, such as significant price reductions and better alignment with clinical benefits. Policymakers in the US, especially for drug classes with multiple therapeutic alternatives, may find EFs valuable in setting prices that reflect comparative clinical benefits.

Reference: jamanetwork.com/journals/jamadermatology/article-abstract/2815167