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In a U-turn, ICER takes more positive view of AbbVie’s Rinvoq

Rheumatoid arthritis drug now falls under quality-adjusted life-year (QALY) threshold

AbbVie Redwood

The Institute for Clinical and Economic Review (ICER) has shifted its position on the value of AbbVie’s Rinvoq (upadacitinib), bringing the rheumatoid arthritis drug under its quality-adjusted life-year (QALY) threshold.

ICER, an independent US cost watchdog, delivered its original assessment of the value of Rinvoq and two rival JAK inhibitors, Pfizer’s Xeljanz (tofacitinib citrate) and Eli Lilly and Incyte’s Olumiant (baricitinib), late last month.

At that time, ICER concluded that the incremental cost-effectiveness of Rinvoq versus AbbVie’s ageing blockbuster Humira (adalimumab) exceeded its $150,000 (£119,000) threshold. The finding dented AbbVie’s hopes of growing sales of Rinvoq to offset the anticipated loss of Humira revenues to biosimilar competitors.

However, within days of releasing the report, ICER issued a statement withdrawing the document on the grounds that it was ‘reevaluating its approach’. Now, ICER has shared the results of the revaluation.

ICER has changed some of the parameters and inputs for the value models described in the report, for example by changing the time horizon from lifetime to one year and moving second-line patients onto immune modulators rather than palliative care.

The changes have cast Rinvoq in a more favourable light. Under the revised model, the incremental QALY for Rinvoq versus Humira came in at $92,000, below the $150,000 threshold used by ICER.

ICER now calculates that the cost per month in remission on Rinvoq compared to Humira is $600. The original report put the cost per year of remission at $71,000, which works out at a per-month figure almost 10 times as big as the latest calculation.

While the revised figures are better for Rinvoq, the report as a whole is still equivocal about the merits of the recently approved therapy. Notably, the statement that Rinvoq ‘provided marginal clinical benefit over adalimumab at higher costs’ survived the revision process.

The revised report also retains a skeptical view about the value of Xeljanz and Olumiant. As in the first draft, ICER concludes that the ‘marginal’ benefit Xeljanz offers over Humira means a price that is ‘much higher’ than AbbVie’s blockbuster ‘may not be justified’. Given that biosimilar competitors for Humira are on the horizon, the finding suggests Pfizer could struggle to sell Xeljanz at a premium price.

ICER is accepting feedback on the draft document for around one month. One of ICER’s independent committees will discuss the document and hold a vote on it in December.

Article by
Phil Taylor

14th October 2019

From: Research

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