RE:Comment on Trogarzo cost in new FDA HIV Guidelines This study was published in Febrauary 21, 2021:
Ibalizumab may be cost effective for the treatment of multidrug-resistant (MDR) HIV-1 infection in the US, according to findings of a Theratechnologies-funded study published in PharmacoEconomics.
A Markov model populated with data from phase II and III trials and market uptake projections was used to evaluate the cost effectiveness of final-line antiretroviral therapy with ibalizumab plus optimised background therapy (OBT) versus OBT alone in adults with MDR HIV-1, from a US healthcare sector perspective over a lifetime time horizon. Budget impact analysis was also performed to estimate the impact of the introduction of add-on ibalizumab on the payer budget of a hypothetical commercial health plan during the first 3 years, and from a Medicare health plan perspective. The assumed cost of ibalizumab was $125 555Footnote1 in the first year and $118 445 per year thereafter, and the assumed annual cost of OBT was $52 850. It was estimated that ibalizumab plus OBT would increase survival by 1.47 years compared with OBT alone, achieving an incremental gain of 1.45 QALYs at an incremental cost of $192 476, resulting in an incremental cost-effectiveness ratio of $133 040 per QALY gained. In a commercial health plan with 1 million members, the addition of ibalizumab to OBT was estimated to increase the budget by $217 260 ($0.018 per member per month [PMPM]) in year 1, $385 245 ($0.032 PMPM) in year 2 and $560 310 ($0.47 PMPM) in year 3. Probabilistic sensitivity analysis found that ibalizumab plus OBT was cost effective versus OBT alone in 73.4% of simulations at a willingness-to-pay threshold of $150 000 per QALY gained. In budget-impact scenario analysis, the budget impact of ibalizumab was found to be greater in a Medicare population ($0.054 PMPM in year 3) but, under all scenarios evaluated, the annual budget impact was less than $0.07 PMPM. "This analysis suggests that ibalizumab treatment may be cost-effective considering willingness-to-pay thresholds for rare diseases and that including ibalizumab on either a commercial or a Medicare health plan formulary may result in a relatively low budget impact," concluded the authors.
In 2020 they had a combined sales of both drugs equaled to $66 M, historic ratio so far 56% Egrifta versus 44% Trogarzo, based on their sale growth forecast the peak sales in 4 years (244%) equals 147M, I wouldn’t think the sale growth forecast would include Europe as the launch of Trogarzo is delayed due to lockdowns although it is already launched in Germany. $147Mx.44%=$65M peak sales in the US, as per the company Europe will have same market opportunity depending on how to interpret that language for instance are they talking about number of patient or sales we end up with two scenarios. If they are referring to sales then we end up with another $65M in Europe total $130M peak sales for Trogarzo, if they are talking about number of patients due to lower drug’s price about $20%, $65M x.0.8=$52M+$65M=$117M peak sales of Trogarzo. A per Egrifta $66Mx56%=$37Mx 244%=$90M peak sales for Egrifta in 4 years. Scenario one we end up with $220M gross revenues and scenario 2, $207M gross revenues for both drugs in 4 years. Of course the revenues for Trogarzo will be shared but there won’t be any cost of goods and Egrifta has a very healthy gross margin.
SPCEO1 wrote: Costs and Cost-effectiveness of ARV Regimens for Highly Treatment-Experienced People with Multidrug-Resistant HIV
For people with multidrug-resistant (MDR) HIV, an ARV regimen that includes intravenous IBA or oral fostemsavir can be effective in achieving viral suppression, but costly. Two cost-effectiveness analyses using independent simulation models have demonstrated that IBA-containing ARV regimens would substantially improve survival for people with MDR HIV but at a high cost per quality-adjusted life-year, given the high cost of IBA. However, the overall budget impact of such regimens would be relatively small, given the limited number of people for whom IBA would be necessary.32, 33