Using Real-World Data to Inform Value-Based Contracts for Cell and Gene Therapies in Medicaid.

ABSTRACT:

Objective

High upfront costs and long-term benefit uncertainties of gene therapies challenge Medicaid budgets, making value-based contracts a potential solution. However, value-based contract design is hindered by cost-offset uncertainty. The aim of this study is to determine actual cost-offsets for valoctocogene roxaparvovec (hemophilia A) and etranacogene dezaparvovec (hemophilia B) from Colorado Medicaid's perspective, defining payback periods and its uncertainty from the perspective of Colorado Medicaid.

Methods

This cost analysis used 2018-2022 data from the Colorado Department of Health Care Policy & Financing to determine standard-of-care costs and employed cost simulation models to estimate the cost of Medicaid if patients switched to gene therapy versus if they did

SUBMITTER: Zemplenyi A 

PROVIDER: S-EPMC10861602 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature