ICER Report Finds New Osteoporosis Drugs Not Cost-Effective

A recent report from the Institute for Clinical and Economic review (ICER) examined three osteoporosis medications—Tymlos (abaloparatide; Radius Health), Forteo (teriparatide; Eli Lilly), and Evenity (romosozumab; Amgen)—and found that the drugs are all too expensive to be considered cost-effective.

“Experts estimate that there are approximately two million osteoporotic fractures each year, which results in $19 billion in related costs,” Douglas Bauer, MD, and Teresa Fama, MD, Clinical Expert Reviewers for ICER, wrote in the report. “By 2025, these figures are predicted to grow to approximately three million fractures and $25 billion in costs annually as the population of older Americans increases.”

The main goal of treatment for patients is to prevent fragility fractures that are associated with osteoporosis—the fractures are commonly found in the hip, spine, and wrists.

In order to assess the cost-effectiveness of the drugs, ICER compared the two new, emerging anabolic therapies Tymlos and Evenity with the other FDA-approved anabolic agent, Forteo. ICER focused on these three treatments because the two new agents were expected to be more effective and more expensive than generic treatments—the standard first-line therapy for most patients.

Although the report concluded that each of the three medications increased both life years and quality-adjusted life years, the agents also increased costs, and ICER reported that they exceeded the commonly-cited cost-effectiveness threshold of $150,000 per quality-adjusted life year. 

Currently, the price for Tymlos is $1186.25 per month which factors in a 27% discount estimated by ICER. Because Amgen has yet to release its list price for Evenity, ICER predicts that Amgen will at least aim to match Eli Lilly’s Forteo which is listed at $1628.45-per pen.

In order to keep the package pricing for each anabolic medication below the $150,000-per-QALY-benchmark, the manufacturers would have to lower their current prices. According to the report, Radius would need to maintain a $692.83 monthly price tag, Eli Lilly would need to get its drug price to $323.65 per pen, and Amgen would have to get its price to $65.96 per month. In order to get prices down to a $50,000-per-QALY target, Amgen would have to price Evenity  at $29.10.

ICER made note that although these findings show a significant cost increase for these drugs, the study had limitations. Due to Amgen’s unknown list price, it is unclear if the company will match Lilly’s price or undercut it similar to Tymlos’s pricing by Radius Health. Additionally, ICER assumed 100% adherence to all treatments which would not typically occur everyday in practices.

—Julie Gould (Mazurkiewicz)