Cost-Based Price Calculation of Mexiletine for Nondystrophic Myotonia |
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Authors: | Sibren van den Berg Vincent van der Wel Saco J. de Visser Bas C. Stunnenberg Lonneke Timmers Martijn H. van der Ree Pieter G. Postema Carla E.M. Hollak |
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Affiliation: | 1. Medicine for Society, Platform at Amsterdam UMC - University of Amsterdam, The Netherlands;2. Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands;3. Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands;4. National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands;5. Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands;6. Department of Endocrinology and Metabolism, Amsterdam UMC - University of Amsterdam, The Netherlands |
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Abstract: | ObjectivesMexiletine is a long-known drug used for the treatment of arrhythmias and repurposed in the 1980s for patients with nondystrophic myotonia (NDM). Recently, the price of mexiletine in Europe increased significantly after registration as an orphan drug for NDM. This led to international discussions on affordability and willingness to reimburse mexiletine in the absence of background information that would justify such a price. Our objective was to calculate a cost-based price for mexiletine for adult patients with NDM based on detailed information on development costs.MethodsWe calculated a fair price based on a cost-based pricing model for commercial mexiletine to treat adults with NDM using a recent European drug-pricing model as a framework to include actual costs incurred. Three scenarios were applied: 1 with minimum estimated costs, 1 with maximum estimated costs, and 1 with costs as if mexiletine was innovative.ResultsThe calculated fair price of mexiletine per patient per year (PPPY) is €452 for the minimum scenario and €1996 for the maximum scenario. By using hypothetical R&D costs used for innovative drugs, the price would be €6685 PPPY. In Europe, the list price of mexiletine ranges from €30 707-60 730 PPPY, based on 600 mg daily.ConclusionsThe current list price for mexiletine in Europe is manifold higher than any scenario of the cost-based models. Accounting for the reduced costs for clinical development in a repurposing scenario, the cost-based pricing model provides a fair commercial price range, which can be used as benchmark for pricing negotiations and/or reimbursement decisions. |
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Keywords: | arrhythmia cost-based drug repurposing fair price mexiletine myotonia orphan drug rare disease VT/VF prevention |
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