Discounts prompt Scots yes to fund Intermune's Esbriet and Gilead's Stribild
This article was originally published in Scrip
Price discounts have helped Intermune and Gilead secure reimbursement recommendations from Scotland's health technology appraisal body, the Scottish Medicines Consortium, for orphan drug Esbriet (pirfenidone) and Stribald (elvitegravir plus cobicistat plus emtricitabine plus tenofovir disoproxil) for HIV-1 patients.
The discounts mean that the firms will be able to secure reimbursement while maintaining a higher list price. This will benefit the companies in the markets that reference UK prices.
In its latest round of funding decisions, the SMC has said yes to Esbriet for treating mild to moderate idiopathic pulmonary fibrosis. The consortium restricted the drug's use to patients with a predicted forced vital capacity less than or equal to 80%.
The company must also offer a confidential discount on the drug's UK list price, in line with a patient access scheme. Similarly, a discount helped the firm persuade NICE, the SMC's English counterpart, decide to recommend the drug for use on England's National Health Service (scripintelligence.com, 22 March 2013). A year's treatment of Esbriet 801mg three times daily doses costs £26,100, excluding any discount.
Intermune put two budget impact scenarios forward to the SMC, which depended on different IPF prevalence rates. The first scenario assumed there would be 792 patients eligible for treatment in the first year that treatment became available, and that the uptake rate among those patients would be 13.5%. The firm projected that this would increase to 806 patients in the fifth year with uptake rate of 18.9%. Excluding the discount, Intermune estimated the net budget impact for this scenario to be £2.041m in year one and £2.915m in year five.
In the second scenario, Intermune estimated the eligible patient population to be lower, with 624 patients in the first year, rising to 633 by the fifth year. The uptake rates remained the same. Again excluding the discount, the firm said the net budget impact would be £1.607m in year one and £2.291m in year five.
The firm planned to have launched the drug in Scotland by the end of August. Pricing and reimbursement has also been approved in Austria, Belgium, Denmark, Finland, France, Germany, Ireland, Italy, Luxembourg, Norway, Sweden and Iceland. Intermune secured reimbursement in Italy through a risk-sharing deal (scripintelligence.com, 19 June 2013).
Stribild
The SMC also agreed to recommend Stribild for HIV-patients aged over 18 years who are antiretroviral treatment-naïve or have no known HIV-1 mutations associated with resistance to the products three active ingredients.
The recommendation depends on a patient access scheme that will see Gilead offer the drug at a confidential discount that makes the drug a more cost-effective option than other treatments, including Gilead/BMS' Atripla (efavirenz, emtricitabine, tenofovir disoproxil). Excluding the patient-access scheme, a year's treatment of Stribild costs £12,555 per patient per year.
Gilead estimated there would be 362 patients eligible for treatment in the first year, when the uptake rate would be 10%, rising to 436 patients and a 20% uptake rate by the fifth year. Without the discount, the firm estimated the drug to have a net budget impact £165,000 in year one and £397,000 in year five.