Utilizing Data for Policies and Cost-Effectiveness of PrEP Agents


Dr Milgram focuses on the cost-effectiveness of cabotegravir as a long-acting injectable PrEP therapy and how providers and payers use data and real-world evidence to create PrEP policies.

Lynne H. Milgram, MD, MBA, CPE: The ISPOR [International Society for Pharmacoeconomics and Outcomes Research 2022 Conference] presentation discussed the results of the HPTN 084 and HPTN 083 studies showing superiority in certain vulnerable groups. That’s important to note when you’re looking at pricing. You also need to look at outcomes and efficacy, especially in a disease like this, or potentially preventing a disease like this, where there are long-term consequences. That particular document might have been more accurate in looking at the benefits of long-term injectables or long-lasting injectables compared with short-acting everyday pills. The biggest takeaway is probably looking at it more holistically and globally.

We haven’t used real-world evidence at all, but we’d be very interested in looking at real-world evidence from organizations like mine, such as Kaiser [Permanente], or even CMS [Centers for Medicare & Medicaid Services], larger data sets. But we’d be interested in looking at the offset of costs. That’s probably thinking more globally or holistically. It would be, we pay X for something, the price is X, but what does it offset? What other costs might it offset?

Real-world evidence would show us maybe less utilization of more expensive drugs, or less utilization of more expensive inpatient services, imaging, or laboratory tests. We use real-world evidence because it gives us more data than at launch. Because we’re large, we might even look at our own real-world data and evidence, but that would take longer. Sometimes when we’re approached by pharmaceutical companies that have clinical trial data, they also have real-world evidence, whether it’s from Europe or other places, that helps us understand the real value of the new drug or medication.

Transcript edited for clarity.

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