Study: Cost-effectiveness of cardiovascular drugs varies widely

The publicly available prices of 30 frequently prescribed cardiovascular drugs don’t necessarily correlate to clinical value, according to a new study. Some drugs were both cheaper and more effective than alternatives, while others were more expensive and associated with poorer outcomes.

“The wide range of cost-effectiveness that we found suggests that drug pricing over the past two decades was not clearly influenced by the clinical value of the medications,” Jonathan D. Campbell, PhD, and colleagues wrote in the August edition of Health Affairs. “As the concept of value for money is maturing in the U.S., the question of how to inform decisions on what is an acceptable cost per unit of health gained is becoming more urgent.”

Campbell et al. reported on the cost-effectiveness of popular cardiovascular drugs by combining their prices with results from randomized clinical trials conducted from 1985 to 2011. The incremental cost-effectiveness ratio (ICER) was measured as cost per quality-adjusted life year (QALY) gained, with each QALY representing a year of perfect health.

In the U.S., the authors noted, cost-effectiveness thresholds have been poorly defined; everywhere from $50,000 to $150,000 per QALY has been deemed appropriate.

But in studying these 30 cardiovascular medications, Campbell and colleagues uncovered a wide range of ICERs.

Five of the 30 trials resulted in ICERs above $175,000 per QALY gained, while the rest were below $100,000 per QALY gained. Four of them were below $0 per QALY gained, meaning they were both less costly and more effective.

“We did not find evidence of an implicit value threshold based on publicly available pricing for commonly prescribed cardiovascular drugs,” the researchers wrote. “The observed range of payments, or long-run savings, for the achievement of one year of perfect health begs for further discussion in the U.S. on how value-based evidence should be used for coverage and reimbursement decisions.”

Most of the drugs were evaluated against a placebo comparator, but six had active comparators. Unsurprisingly, the medications measured against a placebo generally had more impressive relative effects.

The authors used publicly available drug prices for their analyses but acknowledged payers may have negotiated discounts or rebates for their products. In addition, they assumed drugs’ protective effects remained constant until a patient’s death, which is unlikely to be the case for all therapies and outcomes.  

“This assumption resulted in our ICERs being lower (or more favorable) than if we had modeled a decay over time,” Campbell and coauthors said.

As drug therapies advance it is become more challenging to demonstrate an incremental benefit, the researchers noted. This makes it more expensive for drug companies to come up with beneficial innovations and may drive up prices over time, as was observed in this study. The average annual cost of a treatment with an active alternative was $723 more than a drug with a placebo comparator.

All of these trends point to a pressing need to develop and adhere to a specific cost-effectiveness threshold, to ensure patients, pharmaceutical companies and the healthcare system are getting appropriate bang for their buck.

“Clarity on value definitions and value-for-money thresholds should aid in signaling to drug manufacturers how best to use current and future resources,” the researchers noted. “Our study contributes to the growing body of evidence that can help inform payers in making more rational and systematic decisions and innovators in determinations of price.”