U.S. prices for newer multiple myeloma cancer treatments should be cut by as much as 94 percent to justify their value in terms of prolonging life, while there is not enough evidence to assess the benefit of some, according to an independent nonprofit organization that evaluates the effectiveness of medicines.
The report has been criticized by some medical and patient groups for oversimplifying the complex decisions needed to best use new treatment options. The American Society of Hematology, for example, said in posted public comments that the “analysis has only limited value in determining the just price and utility of novel drugs.”
The draft report evaluates regimens including Amgen Inc’s Kyprolis, Takeda Pharmaceutical Co Ltd’s Ninlaro, Bristol-Myers Squibb Co and AbbVie Inc’s Empliciti, Novartis AG’s Farydak, Celgene Corp’s Pomalyst and Johnson Johnson’s Darzalex. The analysis involved treatment for multiple myeloma patients whose disease did not respond to at least one previous therapy or relapsed after such treatment.
The Boston-based Institute for Clinical and Economic Review (ICER), with input from stakeholders including doctors, patients and insurers, assesses the value of high-priced drugs and other medical services in the United States.
The group said it found insufficient evidence to determine a health benefit for multiple myeloma regimens containing Farydak, Pomalyst or Darzalex, due to the structure of clinical trials for those drugs.
The analysis found that each of the remaining treatments extended survival by about a year, compared with standard care with Celgene’s Revlimid and dexamethasone, but the extra costs ranged from a low near $173,000 for the Kyprolis regimen to a high of around $354,000 for the Empliciti regimen. Multiple myeloma, a type of blood cancer that develops in the bone marrow, will be diagnosed in an estimated 30,330 Americans this year, according to the American Cancer Society. ICER said its draft value-based price benchmark for second-line Kyprolis is $673 to $1,267 per vial, or a discount of 32 percent to 64 percent from estimated costs. Its benchmark for Emplicti is $267 to $588 per vial, or a 75 to 89 percent discount, while the benchmark for Ninlaro was $181 to $587 per capsule, representing a discount of 80 to 94 percent.
Takeda said in a statement that it is concerned that ICER’s model has significant limitations and omissions that may result in practice decisions that limit access for patients. Amgen said it remained concerned that “ICER is focused on ringing alarm bells from a payer perspective, rather than focusing on a rigorous analysis that fully reflects the cancer patient perspective of value.”
Officials at the other drugmakers did not immediately respond to requests for comment.
The study used list prices for the drugs, which are often subject to discounting under contracts with health insurers and other payers. Previous reports by ICER included findings that a new class of cholesterol-lowering drugs, one being sold by Amgen and another by Regeneron Pharmaceuticals Inc in partnership with Sanofi, should cost about a third of their list prices to keep costs in line with healthcare budgets and the benefit they bring.
(Reporting by Deena Beasley in Los Angeles; Editing by Bill Rigby and Matthew Lewis)