In the latest update of its evidence report issued yesterday, the Institute for Clinical and Economic Review (ICER) concluded that AbbVie’s JAK inhibitor Rinvoq (upadacitinib) provided a ‘marginal’ benefit over its older drug Humira (adalimumab), but with a higher price tag.
The US-based cost-effectiveness institute set out to assess the comparative clinical effectiveness and economic value of three JAK inhibitors for treating rheumatoid arthritis – AbbVie’s Rinvoq, Pfizer’s Xeljanz (tofacitinib) and Eli Lilly’s Olumiant (baricitinib).
ICER’s original report concluded that the incremental cost-effectiveness of Rinvoq versus AbbVie’s ageing blockbuster Humira exceeded its $150,000 threshold.
That initial finding damaged AbbVie’s hopes of growing sales of Rinvoq to offset the anticipated loss of Humira revenues to biosimilar competitors when it loses its patent exclusivity.
However, ICER quickly pulled back on some of these claims, and withdrew the document on the grounds that it was ‘reevaluating its approach’. The changes made to its assessment – including alterations to the parameters and inputs for the value models described in the report – cast Rinvoq in a more favourable light.
The latest updated report evaluated a head-to-head trial comparing Rinvoq and Humira, which shows that Rinvoq is associated with statistically significant but ‘modestly’ higher rates of disease remission and improvement in other outcomes.
According to ICER, this evidence demonstrates that Rinvoq provides a small to substantial health benenfit over Humira. The institute found that compared to the TNF blocker, Rinvoq’s value-based price benchmark is between $44,000 to $45,000 per year of treatment. This is a significant change from its initial cost-effectiveness threshold.
This amount represented a 25-26% discount on Rinvoq’s annual list price of $59,860 and is consistent with the rebates AbbVie is assumedly already offering.
However, the institute still concluded that Rivoq “provides marginal clinical benefit in comparison to Humira at higher costs”. ICER still has concerns over the long-term impact of drug treatment for rheumatoid arthritis, but many have criticised its methods – including a number of patient organisations – as being unable to determine the benefit of the new class of drugs.
The revised report also determined that Xeljanz had a comparable net health benefit to Humira, while there is no evidence to compare Olumiant to the older treatment.
The evidence report will be reviewed at an upcoming meeting on 9 December.