Entresto, the newly approved medication for the treatment of congestive heart failure, offers a “small to substantial” net benefit compared with current care approaches, but its annual cost would need to be $1,000 less than its list price to be cost-effective for widespread use, according to an analysis.
The Institute for Clinical and Economic Review analyzed the economic value of two interventions for congestive heart failure: Swiss pharmaceutical giant Novartis' new drug Entresto and a St. Jude Medical system known as CardioMEMS HF for monitoring increases in pulmonary artery pressure.
Although the drug provides a clear benefit over standard treatments, the report found, it could impose an excessive financial burden on the U.S. health system because of its potential patient population of more than 1.9 million within its first five years on the market.
“If we're getting good long-term value, we want to try and get that drug or device into the healthcare system for the patients who would benefit from it,” said Dr. Steven Pearson, founder and president of ICER. “But if it's going to be lots and lots of patients and cause a huge budget impact, we can't be unaware that that's going to potentially drive up overall healthcare costs so much that they could kind of get out of whack.”
ICER concluded that lowering Entresto's annual cost from its list price of $4,560 a patient to $3,779, a discount of 17%, would make it cost-effective. It's not unusual, the report noted, for insurers and Medicaid programs to get such discounts.
The Food and Drug Administration approved Entresto in July after concluding it reduced the risk of death and hospitalization over ACE inhibitors, the most commonly used class of drugs for managing congestive heart failure for the past two decades.
The report is the second the organization has released this month assessing the value of new medical treatments. The first looked at the cost effectiveness of PCSK9 inhibitors, a new class of injectable, cholesterol-lowering drugs that received FDA approval over the summer and have been listed at an annual cost of $14,000.
That report found that the annual cost for Sanofi's Praluent and Amgen's Repatha would have to be lowered by 82%, to about $2,520, to make them cost-effective.
Both reports come at a time when sentiment over the high cost of new drugs has led to calls by patients' advocates and insurers for more transparency in the way pharmaceutical firms set their prices. A February article in Health Affairs projected that long-term use of PCSK9 inhibitors would dwarf the costs of the new breed of hepatitis C drugs such as Sovaldi, which sparked the ongoing debate about drug costs when they were introduced last year.
The ICER report issued Friday also looked at a St. Jude Medical device system called CardioMEMS HF, which was approved in 2014 for measuring and monitoring pulmonary artery pressures and heart rate in heart failure patients. The researchers concluded that current evidence was "insufficient" to determine whether the device improved overall patient outcomes and that its list price of $17,750 exceeds by 60% the threshold that "indicates an excessive cost to the overall healthcare system."