Pricing methods in outcome-based contracting: δ1: cost effectiveness analysis and cost-utility analysis-based pricing

Figures & data

Figure 1. Cost-effectiveness analysis and cost-utility analysis-based pricing. Abbreviations. CEA, cost-effectiveness analysis; CUA, cost-utility analysis; CEAC, cost-effectiveness acceptability curve; DSP, dimension-specific price.

Table 1. Model inputs.

Inputs for cost-effectiveness and utility analysis	Mean value	References
Overall survival (OS)	OS Kaplan–Meier curve	Soria et al. [10]
Progression-free survival (PFS)	PFS Kaplan–Meier curve	Soria et al. [10]
Cost inputs (2018 U.S. dollars)
Osimertinib^a	$14,616	RedBook [11]
Gefitinib^a	$7,711	RedBook [11]
Erlotinib^a	$8,451	RedBook [11]
Cost of progression	$19,274	Skinner [12]
Cost of monitoring	$1,150	Aguiar [13]
Fatigue	$11,905	Ting [14]
Diarrhea	$9,323	Ting [14]
Rash or acne	$8,545	Ting [14]
Stomatitis	$11,252	Ting [14]
Anemia	$1,038	Roy [15]
Dyspnea	$11,817	Roy [15]
Utility values
Progression-free	0.630	Aguiar [13]
Progression	0.473	Aguiar [13]
Death	0
Disutility values
Fatigue	0.073	Nafees [16]
Diarrhea	0.047	Nafees [16]
Rash or acne	0.033	Nafees [16]
Stomatitis	0.131	Nafees [16]
Anemia	0.067	Nafees [16]
Dyspnea	0.049	Nafees [16]
Inputs for the hypothetical outcome-based contracts
Medical Inflation rate projected for 2019–2020	0.44%	U.S. Bureau of Labor Statistics [7]
Medical Inflation rate projected for 2019–2021	0.72%	U.S. Bureau of Labor Statistics [7]

^aThe price of treatments is based on the whole acquisition cost of a 30-day prescription in 2018 U.S. dollars.

Table 2. Results of cost-effectiveness and cost-utility analyses.

	Cost	LY gained	QALY gained
Base-case analysis
Osimertinib	$714,826	5.67	2.91
SOC^a	$465,660	3.22	1.68
ICER/ICUR		$101,700/LY	$202,574/QALY
Probabilistic sensitivity analysis
Osimertinib	$703,489	5.49	2.85
SOC^a	$495,333	3.38	1.78
ICER/ICUR		$98,652/LY	$194,538/QALY

^aThe cost of standard of care was weighted per FLAURA: 66% for gefitinib and 34% for erlotinib.

Abbreviations. LY, life year gained; QALY, quality-adjusted life year gained; ICER, incremental cost-effectiveness ratio; ICUR, incremental cost-utility ratio; SOC, standard of care (erlotinib and gefitinib).

Figure 2. Cost-effectiveness acceptability curves (CEAC). (A) PSA ICER-generated CEAC; (B) PSA ICUR-generated CEAC.

Table 3. Prices of osimertinib suggested per two hypothetical contracts (2019–2020 and 2019–2021).

Certainty of cost-effectiveness and cost-utility analysis-based pricing	1-year contract (2019–2020)^a	2-year contract (2019–2021)^b
Certainty of cost-effectiveness analysis-based pricing
0% certainty of CEA	$0	$0
Turning point% certainty of CEA (50%)	$14,680	$14,721
100% certainty of CEA	$41,666	$41,782
Certainty of cost-utility analysis-based pricing
0% certainty of CUA	$0	$0
Turning point% certainty of CUA (50%)	$14,680	$14,721
100% certainty of CUA	$28,072	$28,150
Average osimertinib price (SD)	$16,516 ($16,238)	$16,562 ($16,283)
DSPCEA/CUA (% price adjustment)^c	$16,391 (+12.14%)	$16,677 (+14.10%)

^aInflation rate in 2019–2020 was projected at 0.4395833% but rounded to 0.44% for reporting.

^cInflation rate in 2019–2021 was projected at 0.71875% but rounded to 0.72% for reporting.

^cPrice adjustment to 2018 WAC price of osimertinib for 30-day prescription.

Abbreviations. DSP_CEA/CUA, dimension-specific price in δ1; CEA, cost-effectiveness analysis; CUA, cost-utility analysis.

Soria J, Ohe Y, Vansteenkiste J, et al. Osimertinib in untreated EGFR-mutated advanced non–small-cell lung cancer. N Engl J Med. 2018;378:113–125.

 PubMed Web of Science ®Google Scholar

RedBook Online [subscription database online]. Greenwood Village (CO): Truven Health Analytics. [accessed December 2019, updated periodically]. Available from: http://micromedex.com/products/product-suites/clinical-knowledge/redbook

 Google Scholar

Skinner KE, Fernandes AW, Walker MS, et al. Healthcare costs in patients with advanced non-small cell lung cancer and disease progression during targeted therapy: a real-world observational study. J Med Econ. 2018;21:192–200.

 PubMed Web of Science ®Google Scholar

Aguiar J, Pedro N, Haaland B, et al. cost-effectiveness of osimertinib in the first-line treatment of patients with EGFR-mutated advanced Non-Small Cell Lung Cancer. JAMA Oncol. 2018;4:1080–1084.

 PubMed Web of Science ®Google Scholar

Ting J, Tien Ho P, Xiang P, et al. Cost-effectiveness and value of information of erlotinib, afatinib, and cisplatin-pemetrexed for first-line treatment of advanced EGFR mutation-positive non-small-cell lung cancer in the united states. Value Health. 2015;18:774–782.

 PubMed Web of Science ®Google Scholar

Roy A, Kish JK, Bloudek L, et al. Estimating the costs of therapy in patients with relapsed and/or refractory multiple myeloma: a model framework. Am Health Drug Benefits. 2015;8:204–215.

 PubMed Web of Science ®Google Scholar

Nafees B, Stafford M, Gavriel S, et al. Health state utilities for non small cell lung cancer. Health Qual Life Outcomes. 2008;6:84.

 PubMed Web of Science ®Google Scholar

U.S. Bureau of Labor Statistics. Prescription drugs in U.S. city average, all urban consumers, seasonally adjusted. [accessed December 2019]. Available from: https://data.bls.gov/timeseries/CUSR0000SEMF01?output_view=pct_3mths

 Google Scholar