Humira Not Cost Effective for RA, ICER Report Concludes


Adalimumab (Humira), the best-selling medication globally, is not worth its current price and doesn’t work as well as 2 of its competitors, according to a new report from the Institute for Clinical and Economic Review (ICER), an independent nonprofit organization that seeks to improve healthcare value by providing comprehensive clinical and cost-effectiveness analyses of treatments, tests, and procedures.

Overall, the report concludes, targeted immune-modulating (TIM) rheumatoid arthritis (RA) drugs work better than older treatments such as methotrexate, but the prices of TIMs detracted from ICER’s cost-effectiveness rating, which is based on a quality-adjusted life-year (QALY) analysis. According to ICER, most immune modulators exceed traditional cost/QALY analysis thresholds.

To be designated as cost effective by ICER, adalimumab’s net price would need to be at a 50% to 69% discount of the list price. None of its competitors, tumor necrosis factor (TNF)-alpha or other classes, hit ICER’s benchmark for value, per ICER’s report, Targeted Immune Modulators for Rheumatoid Arthritis: Effectiveness & Value, which was released April 7, 2017.

AbbeVie, the maker of adalimumab, has taken issue with the report’s conclusions and said ICER’s methodology was flawed. Analysts say that while the report is not likely to have much of an effect on adalimumab’s sales for now, it might affect pricing decisions on forthcoming novel medications and the need for those novel medications with payers. The report could potentially also affect pricing on adalimumab’s biosimilars when they are marketed.

Humira had the highest per-QALY cost of the TNF-alpha inhibitors at $232,644; infliximab (Remicade) came in the lowest at $202,824. Tocilzumab (Actemra), an IL-6 inhibitor, had the lowest overall cost at $168,600 per-QALY cost. ICER’s report noted that based on head-to-head data on effectiveness versus adalimumab, etanercept (Enbrel) was comparable in lowering disease activity; certolizumab (Cimzia) and abatacept (Orencia) matched on a variety of measures. Tocilzumab was superior to Humira at decreasing disease activity and on one common assessment scale.

The report also included comparative analyses of 2 investigational RA drugs, baricitinib (Olumiant, JAK inhibitor) and sarilumab (Kevzara, an IL-6 inhibitor), which were superior to Humira at lowering disease activity and 2 other assessment tools.

ICER’s effectiveness analyses gave Humira a “C” rating. ICER’s endorsement for moderate certainty of incremental or better benefit generally requires that a treatment receive a B+ grade.

The report concludes that although all the TIMs evaluated substantially improved health outcomes compared with conventional disease-modifying antirheumatic drugs (DMARDs) alone, their additional cost led to cost-effectiveness estimates that were well above commonly cited thresholds for cost-effectiveness, and the discounts required to achieve these thresholds are greater than estimated current discounts from wholesale acquisition costs. Compared with the market leader adalimumab, most TIMs in combination with conventional DMARDs were more favorable (lower costs and higher QALYs), ICER said.

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