title: The application of pharmacoeconomic modelling to estimate a value-based price for new cancer drugs.
abstract: OBJECTIVE
  Value-based pricing has recently been discussed by international bodies as a means to estimate a drug price that is linked to the benefits it offers patients and society. The World Health Organization (WHO) has recommended using three times a country's per capita gross domestic product (GDP) as the threshold for economic value. Using the WHO criteria, pharmacoeconomic modelling was used to illustrate the application of value-based price towards bevacizumab, a relatively new drug that provides a 1.4-month survival benefit to patients with metastatic colorectal cancer (mCRC).
  
  
  METHODS
  A decision model was developed to simulate outcomes in mCRC patients receiving chemotherapy ± bevacizumab. Clinical data were obtained from randomized trials and costs from Canadian cancer centres. Utility estimates were determined by interviewing 24 oncology nurses and pharmacists. A price per dose of bevacizumab was then estimated using a target threshold of $CAD117,000 per quality adjusted life year gained, which is three times the Canadian per capita GDP.
  
  
  RESULTS
  For a 1.4-month survival benefit, a price of $CAD830 per dose would be considered cost-effective from the Canadian public health care perspective. If the drug were able to improve patient quality of life or survival from 1.4 to 3 months, the drug price could increase to $CAD1560 and $CAD2180 and still be considered cost-effective.
  
  
  CONCLUSIONS
  The use of the WHO criteria for estimating a value-based price is feasible, but a balance between what patients/governments can afford to pay and the commercial viability of the product in the reference country would be required.
authors.affiliation: Department of Pharmacy, Nelson Mandela Metropolitan University, Port Elizabeth, South Africa. gdranit@ca.inter.net
authors.forename: George
authors.initials: G
authors.lastname: Dranitsaris
authors.forename: Ilse
authors.initials: I
authors.lastname: Truter
authors.forename: Martie S
authors.initials: MS
authors.lastname: Lubbe
authors.forename: Wayne
authors.initials: W
authors.lastname: Cottrell
authors.forename: Biljana
authors.initials: B
authors.lastname: Spirovski
authors.forename: Jonathan
authors.initials: J
authors.lastname: Edwards
mesh_terms: D020533:Angiogenesis Inhibitors / Q000191:economics*; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics; D000068258:Bevacizumab; D002170:Canada; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D018450:Disease Progression; D016527:Drug Costs; D004345:Drug Industry / Q000191:economics; D017850:Economics, Pharmaceutical; D006801:Humans; D018803:Models, Economic; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab