For its latest high-profile review, the US Institute for Clinical and Economic Review (ICER) concluded that the three COVID-19 pills it reviewed all represented good value for money. This is extremely unusual, as a recent GlobalData examination of ICER appraisals found that only 10% of reviewed drugs fell within ICER’s cost-effectiveness threshold. ICER president Steven Pearson stated that one key takeaway from this assessment is that the US government’s involvement in price negotiation via the advance purchase agreement (APA ) framework was effective in reducing the financial uncertainty that could have deterred manufacturers from bringing a drug to the market, and ultimately resulted in multiple drugs becoming available in a relatively short time at prices that were aligned with their clinical benefit.

The three drugs, Lagevrio (molnupiravir), Paxlovid (nirmatrelvir/ritonavir), and fluvoxamine, were evaluated for the treatment of mild-to-moderate COVID-19 among patients at high risk of progression to severe disease. Lagevrio and Paxlovid are available under Emergency Use Authorization (EUA) from the FDA. An EUA for the now genericized fluvoxamine was declined on May 16, 2022, due to insufficient efficacy data.

Treatment cost between $529–707 deemed reasonable

In its final evidence report, published on May 10, ICER concluded that Pfizer ‘s Paxlovid (nirmatrelvir + ritonavir) and fluvoxamine both demonstrated net health benefit, unlike Merck ‘s Lagevrio (molnupiravir).

Most notably, all three drugs were found to be priced reasonably. Uniquely, the prices of COVID-19 drugs are not freely set by the company but are the product of price negotiations with the US government, at least for Paxlovid and Lagevrio. According to ICER, the cost per treatment course for Lagevrio is $707, the cost for Paxlovid is $529, and the cost for fluvoxamine is $12.

At these current prices, ICER concluded that all three drugs appear to have prices that are reasonably aligned with patient benefits and that fell below the level of ICER’s health benefit price benchmarks, which are derived from cost-effectiveness modelling. Given the uncertainty regarding Lagevrio’s net health benefit, the majority of the panel voted that it represents “low-to-intermediate” long-term value for money. Fluvoxamine was found to have “intermediate-to-high” long-term value for money. The panel voted that Paxlovid represents “high” long-term value. It was noted, however, that Paxlovid demonstrated drug interactions that might limit its use.

Global cost comparison highlights huge differences

The competitive landscape for COVID-19 treatments has changed in the period of time it took ICER to conduct the review, and other oral and infusion treatments are now available worldwide. In particular, two monoclonal antibody treatments, Ronapreve (casirivimab/imdevimab) and Xevudy (sotrovimab), have been rolled out in a few markets, and the latter is now available under an EUA in the US.

GlobalData pricing data suggests huge discrepancies between markets as well as between treatments. Many countries have reached confidential pricing agreement with COVID-19 drug makers ahead of marketing authorization and launch. And now that these treatments are gradually rolled out, we can take a look at their prices. Our data suggests that a full treatment cost for new originator drugs in the COVID-19 space ranges from $8.98 for Paxlovid in France to $2,480 for Xevudy in the UK.

With treatment cost averaging $2,200, the monoclonal antibodies authorized for use against COVID-19 are priced significantly higher than Paxlovid and Lagevrio, whose costs do not exceed $688 in Australia and $707 in the US, respectively. For Paxlovid and Lagevrio, cost data extracted from our Poli database echoes the ICER opinion and suggests that the cost for a full treatment cycle in the US is quite reasonable compared to other markets and treatments. This is the result of a favorable purchasing agreement sealed between the federal government and the drug manufacturers, in a country commonly used to rank in the higher-tier markets in terms of drug prices.