On Oct. 29 in Oakland, members of the California Technology Assessment Forum (CTAF) are expected to discuss and debate a report on the cost effectiveness of two recently FDA-approved heart failure treatments.
The analysis from the Institute for Clinical and Economic Review (ICER) found that sacubitril/valsartan (Entresto, Novartis) was cost effective, while the list price of the CardioMEMS heart failure system (St. Jude Medical) device was too high to meet ICER’s value-based price benchmark.
The ICER researchers noted the value-based price benchmark of the CardioMEMS system should be $7,622, a nearly 60 percent discount from its $17,750 list price, which does not include costs associated with surgical implantation and monitoring. The CardioMEMS system, which the FDA approved in May 2014, is the first permanently implantable wireless system intended to measure the pulmonary artery pressures and heart rates of patients with New York Heart Association Class III heart failure who have been hospitalized for heart failure in the previous year.
Meanwhile, sacubitril/valsartan’s wholesale acquisition cost of $4,560 per year is less than ICER’s value-based price benchmark of $3,779 per year. However, ICER’s researchers noted the discounted price is within the range payers can usually negotiate. In July, the FDA approved sacubitril/valsartan, a twice-daily oral medication to treat patients with heart failure and reduced ejection fraction.
The CTAF, an affiliate of ICER, includes experts in medical ethics, outcomes research, consumer advocacy and technology assessment as well as clinicians and methodologists. At the Oct. 29 meeting, which is free and open to the public, CTAF members will work with a roundtable of policy experts to determine cost-effective strategies for covering the treatments.
With the federal government and health insurance companies paying more attention to the prices of medications and devices, organizations such as ICER and CTAF provide a valuable resource in analyzing the costs and benefits of new treatments.
“Figuring out the effectiveness and value of new drugs and devices is not merely an academic exercise,” Steven D. Pearson, MD, MSc, ICER’s founder and president, said in a news release. “The headlines are full of stories about rising health care costs and their impact on patients, families, and the budgets of states and the federal government. A clear-eyed view of the evidence is critical to all members of the health care community as we try to figure out what should be used, which patients benefit most, and at what price innovative treatments represent a reasonable value.”