SummaryIn recent years, several new U.S. Food and Drug Administration-approved, direct-acting antiviral medications to treat the chronic hepatitis C virus (HCV) have entered the market. Because of the potential impact on health plan and pharmacy budgets, researchers have conducted economic analyses, including cost-effectiveness analyses, to understand the value of the new medications.
Experts at Avalere reviewed available health economics literature, from the payer perspective, to determine if cost-effectiveness models assessing new direct-acting antivirals used market-based pricing rather than medication list pricing, which does not factor in discounts. While the models revealed that the drugs generally were cost effective, many models that Avalere analyzed used list pricing instead of using market-based pricing that reflects the net cost to plans as suggested by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. Using list pricing as a benchmark may not reflect the actual price paid by the customer, which could potentially lead to miscalculating the cost-effectiveness of the treatment and an undervaluation of the medication being assessed.
The Avalere analysis concludes that as various assessment organizations and researchers determine the clinical and economic value of new and innovative therapies, it is important that they use sound methodologies to provide payers, consumers, and others with accurate information regarding the costs and cost effectiveness of the new drugs.
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