Ivacaftor not cost effective in cystic fibrosis with G551D mutation
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Ivacaftor not cost effective in cystic fibrosis with G551D mutation Ivacaftor is not cost effective in patients with cystic fibrosis (CF) with the G551D mutation, according to findings of a US cost-utility analysis published in Value in Health. As part of an evidence report by the US Institute for Clinical and Economic Review, a microsimulation model populated with data from the STRIVE and ENVISION trials and the 2016 CF Foundation patient registry was used to evaluate the cost effectiveness of ivacaftor plus best supportive care (BSC) versus BSC alone in a hypothetical cohort of 10 000 infants 6 months of age with the G551D gating mutation. Cost effectiveness was assessed from a US healthcare payer perspective over a lifetime time horizon. The assumed cost of ivacaftor was $426.70 per tablet ($311 704 per year). Ivacaftor was estimated to achieve a greater QALY gain then BSC alone (22.92 vs 16.12 QALYs) at a much greater total cost ($8 797 840* vs $2 336 366), resulting in an incremental cost-effectiveness ratio (ICER) of $950 217 per QALY gained. Probabilistic sensitivity analysis found that there was 0% probability that ivacaftor plus BSC was cost-effective versus BSC alone at a willingness-to-pay (WTP) threshold of $500 000 per QALY gained. In scenario analyses, estimated ICERs were $336 482 per QALY gained with cost discounting, $252 818 per QALY gained with a 90% reduction in drug price after patent expiry in 2027, and $89 461 per QALY gained with both of these. From a societal perspective, the estimated ICER was $958 683 per QALY gained. In threshold analysis, it was estimated that the current cost of ivacaftor, an 83% discount would be required to meet the WTP threshold of $50 000 per QALY gained. "Our findings indicate substantial benefits associated with ivacaftor treatment at a substantial increase in lifetime cost of care among US CF patients with the G551D gating mutation. Ivacaftor treatment plus best supportive care versus best supportive care alone is not cost-effective at or near commonly accepted WTP thresholds," concluded the authors. * 2019 US dollars Wherry K, et al. Cost-Effectiveness of Ivacaftor Therapy for Treatment of Cystic Fibrosis Patients With the G551D Gating Mutation. Value in Health : 16 Aug 2020. Available from: URL: https://doi.org/10.1016/j.jval.2020.05.016
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PharmacoEconomics & Outcomes News 5 Sep 2020 No. 861
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