- ⁃Drugs that increase quality-adjusted survival might not be cost-effective even at a price of zero due to costs beyond the influence of the drug.
- ⁃The zero-price conundrum is relevant for health care systems that require evidence of cost-effectiveness at a given price, in addition to evidence of safety and efficacy for drug approval, and other analyses that may shape drug coverage policies, such as budget impact and comparative effectiveness.
- ⁃Some proposed modifications to cost-effectiveness analysis include excluding disease background costs and assessing each drug in a combination regimen based on its relative contribution to improved health.
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Publication stageIn Press Accepted Manuscript
Cost-effectiveness threshold analyses were conducted to explore scenarios in which clinically effective drugs might not be deemed cost-effective even if priced at zero.
AUTHOR DISCLOSURES [VIH-2022-0432]
Concept and design: Barnett, Bell, Mader, Mladsi, Russell-Smith, Unuigbe
Acquisition of data: Barnett, Mladsi
Analysis and interpretation of data: Barnett, Bell, Mader, Mladsi, Russell-Smith
Drafting of the manuscript: Barnett, Bell, Mader, Mladsi, Russell-Smith, Unuigbe
Critical revision of the paper for important intellectual content: Barnett, Bell, Mladsi, Russell-Smith, Unuigbe
Statistical analysis: Barnett, Mladsi
Provision of study materials or patients:
Obtaining funding: Bell
Administrative, technical, or logistic support: Bell
Supervision: Barnett, Bell, Mladsi
Conflict of Interest Disclosures: Ms Mladsi and Dr Barnett are employed by RTI Health Solutions and reported receiving funding from Pfizer, Inc. during the conduct of the study. Dr Mader was employed by RTI Health Solutions and reported receiving funding from Pfizer, Inc. during the conduct of this study. Mr Bell reported that he was a Pfizer, Inc. employee during the conduct of this study and owned stock in the company. Mr Russell-Smith is employed by Pfizer R&D UK Ltd, and owns stock in the company. Dr Unuigbe had a fellowship funded by Pfizer, Inc. during the conduct of this study. No other disclosures were reported.
Funding/Support: This study was sponsored in part by Pfizer, Inc.
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Acknowledgment: Editorial support for this publication was provided by RTI International, Research Triangle Park, NC, USA (funded by Pfizer, Inc.).