key: cord-0939514-upvdrt8t
authors: Akunne, C.; Connelly, B.; Bathija, S.
title: PIN8 Application of Innovative Pricing in Response to the COVID-19 Pandemic
date: 2021-06-30
journal: Value in Health
DOI: 10.1016/j.jval.2021.04.568
sha: bd2ca4b05ae7b48ab5c0e92d696501b5c45f5502
doc_id: 939514
cord_uid: upvdrt8t

nan

The National Advisory on Canadian Immunizations recommends the two-dose recombinant zoster vaccine (RZV) for prevention of herpes zoster in adults $50 years old. Research shows only 65%-75% of vaccine recipients in Canada complete the RZV series, the reason for which is unclear. Literature on factors influencing multi-dose vaccine completion among adults is limited as most adult vaccines are single-dose. Qualitative research from the perspectives of healthcare providers (HCPs) and vaccine recipients can provide insights on multi-dose vaccine compliance and completion through the generation of rich and nuanced data. The qualitative research methodology that will be used to explore HCP and vaccine recipient attitudes, barriers, and facilitators related to completing the RZV regimen is described. Two rounds of one-on-one semi-structured concept elicitation (CE) interviews will be conducted via telephone/webcam. CE is commonly used in qualitative research to better understand a condition, disease, or treatment experience. The first round of interviews will involve up to 12 HCPs. The second will examine up to 40 healthy adults $50 years old, who have received $1 RZV doses. Concepts identified in HCP interviews will be incorporated into subsequent interviews with vaccine recipients. Sample size will be determined when saturation of concepts, i.e. the point at which no new concepts emerge from interviews, is reached. All interview transcripts will be coded and analyzed using a two-part thematic analysis approach incorporating both codes developed in advance and those developed and refined in an on-going manner as transcripts are reviewed and analyzed. This mix of coding methods will ensure aspects of interest are addressed while leaving room to consider new concepts, descriptions, and experiences. This qualitative study will yield insights that may help inform relevant stakeholders of novel approaches to improve RZV series completion to optimize protection against herpes zoster and offer a basis for future research.

Akunne C, Connelly B, Bathija S PAREXEL International, Horsham, PA, USA Objectives: Indication-based pricing (IBP) allows for discriminatory pricing of a drug based on the specific value offered per indication. Due to the ongoing COVID-19 pandemic, numerous drugs indicated for treatment of other diseases are being assessed to determine potential efficacy for treatment of COVID-19. The aim of this research was to identify therapies that are being evaluated for COVID-19 treatment, assess if these therapies are also used in the treatment of other diseases, and characterize the potential pricing implications for use as a treatment of COVID-19. Methods: Phase III, randomized trials for the treatment of COVID-19 with primary completion date between December 1, 2020 to November 30, 2021 were extracted from Trialtrove. Wholesale acquisition cost (WAC) prices (per unit) were retrieved from Medi-Span Price Rx. Costs for acute and chronic treatments were subsequently calculated based on treatment course and annual treatment costs, respectively. Results: Overall, 89 trials assessing 48 regulatory-approved therapies were identified. Trials (n=69) which investigated vaccines, natural products, generics, non-USapproved indications, and use of existing therapies as prophylactics were excluded. Overall, 20 trials assessing 11 therapies were included. Of these, the majority were anti-inflammatory treatments (n=3; 27%). There was considerable variability in the annual treatment costs for chronic treatments (w$2,200 to w$480,300). Additionally, the cost per treatment course for acute treatments (n=2) ranged from w$725 to w$3,120, the latter being remdesivir, the only approved COVID-19 treatment. Conclusions: Many therapies that are being evaluated for treatment of COVID-19 present a wide range of costs for their previously approved indication(s). Given that their treatment duration and value offered in treatment of COVID-19 will be different compared with chronic treatments, innovative indication-based pricing approach would help support both access and a value-based price. Objectives: Gram-negative bacterial (GNB) infections have become increasingly difficult to treat due to raising antimicrobial resistance rates in Latin America. The development of new antimicrobial agents is urgent to address resistance mechanisms that current molecules do not tackle. Ceftolozane-tazobactam (C/T) is a beta-lactam-beta-lactamase inhibitor agent that can be considered a clinical option for nosocomial pneumonia in critically ill patients at a high risk of meropenem and piperacillin-tazobactam resistant isolates. Methods: We applied a model based on a short-term decision tree and 10-year Markov model. This model represents a hospital microbiota where hospitalized patients could be at risk of nosocomial pneumonia (NP) caused by Enterobacterales or Pseudomonas aeruginosa and should receive empiric antimicrobial therapy. The pathogens distribution was adapted from a 2018-2019 Brazil subsample in a global pathogen surveillance database. Clinical outcomes were extracted from a phase 3 trial of NP patients comparing C/T against meropenem. The most common antimicrobials used in NP (piperacillin-tazobactam and meropenem) were selected as comparators. Costs considered were obtained through publications and publicly available databases considering the Brazilian private healthcare perspective. A 5% discount rate was applied to costs and outcomes. Results: When compared to meropenem, the use of C/T can reduce mortality from 32.7% to 29.0%. The use of C/T resulted in 0.22 incremental QALYs with R$10,967.62 incremental costs resulting in an ICER of R$50,701.38/QALY. Considering piperacillintazobactam as comparator mortality could decrease from 36.3% to 29.0%, generating 0.93 additional QALYs with R$948.33 additional costs, resulting in an ICER of R$1,019.66/QALY. Antimicrobials accounts for 14.8% of total costs when considering treatment, hospital resource use, adverse events and patient monitoring. Against both comparators the C/T arm patients presented shorter ventilator and ICU length of Stay. Conclusions: C/T could be a cost-effective option for NP in the Brazilian private healthcare system according to the World Health Organization's threshold.

Park S, 1 Oh HW 2 1 SANOFI-AVENTIS KOREA CO., LTD., Seoul, Korea, Republic of (South), 2 SANOFI PASTEUR LTD., Seoul, Korea, Republic of (South) Objectives: Multivalent vaccines have brought public health and economic benefits by covering new antigens without increasing the number of injections. A fully liquid hexavalent vaccine, Hexaxim ® (DTaP-IPV-Hib-HepB) has been approved in Korea with proven immunogenicity and safety compared to pentavalent DTaP-IPV/Hib co-administered with standalone Hep B vaccine. This research aims to evaluate the socio-economic impact of introducing Hexaxim ® in Korean national immunization program (NIP). Methods: A cost-minimization analysis was performed with a societal perspective over a 1-year time horizon. Vaccines acquisition, administration, immunization error related costs, parents' transportation and time costs were considered in the model. The probabilities of immunization error were obtained from Time and Motion study, which showed that a fully liquid vaccine significantly reduced the preparation time and resulted in fewer immunization errors. Data on birth cohort, vaccine coverage rate, transportation cost and hourly gross wage were collected from official national sources. In order to obtain the number of hospital visits for inoculation, a nationwide online market research (N=400) was carried out in August 2020. Parents' time costs were estimated by Opportunity Cost Methods, but different approaches also explored in the sensitivity analysis. Results: If Korea switches from the current pentavalent DTaP-IPV/Hib plus HepB to Hexaxim ® for NIP, it will provide 33.2 billion KRW (=29 million USD) substantial cost-savings over the coming year. This was mainly attributable to parents' time savings by reducing hospital visits. Reducing transportation, inoculation fee and immunization errors were also contributing factors. Sensitivity analyses indicated that results were robust to the different valuation approaches. Conclusions: Our research demonstrates the socio-economic value of Hexaxim ® beyond clinical evidences. Additional practical benefits of Hexaxim ® such as reducing storage, distribution and preparation steps, which were not fully captured in this analysis, could be considered from HCP's perspectives. These results would support evidence-based decision-making on the introduction of Hexaxim ® in Korea NIP. 

Dolutegravir/lamivudine (DTG/3TC) is a two-drug regimen FDAapproved in 2019 and currently, the lowest priced single-tablet regimen (STR) based on wholesale acquisition costs. This study evaluates healthcare costs of DTG/ 3TC users compared to current standard of care three-or four-drug STRs. Methods: This retrospective study used IQVIA PharMetrics ® Plus claims (1/1/2015-3/ 31/2020) from US adult patients with a diagnosis of HIV, $1 dispensing of DTG/ 3TC