Comparison of Ophthalmic Medication Prices Between the United States and Australia

Abstract

Importance Health care prices may drive differences in health care costs across high-income nations. Adalimumab, ranibizumab, and aflibercept are high-cost medications in the United States and Australia. A comparison of their prices over time may elucidate how ophthalmic medication prices contribute to health care costs. Objective To compare changes in the prices of adalimumab, ranibizumab, and aflibercept in the United States and Australia, the highest and lowest spenders on health care, respectively, among high-income nations. Design, Setting, and Participants This retrospective price comparison study examined prices paid by government entities in the United States (Medicare) and Australia (Pharmaceuticals and Benefits Scheme). The analysis and data collection were conducted from March 28 to May 4, 2018, in accordance with guidelines set by the International Society for Pharmacoeconomics and Outcomes Research Task Force on Good Research Practices and prior published studies. No human participants or related data were included in this study. Exposures The change in mean prices of adalimumab, ranibizumab, and aflibercept in the United States and Australia. Main Outcomes and Measures Initial, final, and change in medication price annually from 2013 to 2017 in inflation-adjusted 2017 US dollars. Results The mean prices (US dollar prices unadjusted for inflation) in 2013 and 2017 in the United States were $1114 ($1053) and $1818 ($1818), respectively, for adalimumab; $2102 ($1988) and $1904 ($1904), respectively, for ranibizumab; and $2074 ($1961) and $1956 ($1956), respectively, for aflibercept. The mean (Australian dollar prices unadjusted for inflation) 2013 and 2017 prices in Australia were $1854 (A $1797) and $1206 (A $1574), respectively, for adalimumab; $2157 (A $2090) and $972 (A $1268), respectively, for ranibizumab; and $2030 ($1967) and $996 ($1300), respectively, for aflibercept. The estimated annual change in price for adalimumab was +12.8% (95% CI, 9.1%-16.5%) in the United States compared with −11.1% (95% CI, −15.0% to −7.1%) in Australia, a difference of 23.9% per year (95% CI, 19.7%-28.0%; P\u2009<\u2009.001). The annual change in price for ranibizumab was −2.6% (95% CI, −3.9% to −1.3%) in the United States compared with −18.5% (95% CI, −29.3% to −7.8%) in Australia, a difference of 15.9% per year (95% CI, 7.6%-24.2%; P\u2009=\u2009.003). The annual change in price for aflibercept was −1.5% (95% CI, −2.2% to −0.7%) in the United States compared with −16.9% (95% CI, −25.1% to −8.6%) in Australia, a difference of 15.4% (95% CI, 9.1%-21.8%; P\u2009=\u2009.001). Conclusions and Relevance Results of this study indicate that the prices of adalimumab, ranibizumab, and aflibercept significantly decreased during the past 5 years in Australia compared with the United States. These data do not indicate why these differences are noted or what actions might affect future pricing in either country.