A comparative analysis of international health technology assessments for novel gene silencing therapies: patisiran and inotersen

Authors

  • Sergio Iannazzo Hetegy, Turin - Italy *

DOI:

https://doi.org/10.33393/grhta.2021.2193

Keywords:

hATTR, Health technology assessment, Hereditary transthyretin-mediated amyloidosis, Inotersen, ONPATTRO, Patisiran, TEGSEDI

Abstract

Objectives: Using the case study of patisiran and inotersen, we conducted a narrative comparative analysis of the health technology assessment (HTA) agency appraisals of these two first-in-class transthyretin gene silencers, which represent exceptional advances in the treatment of hereditary transthyretin-mediated (hATTR) amyloidosis, a rare and multisystemic disease. Despite the impact of each product on the treatment landscape, the majority of HTAs are only considered standard of care as a comparator, resulting in a void of information and limited comprehension of the clinical and pharmacoeconomic differences between the two treatments.

Methods: A search was conducted internationally for HTA reports, and only instances where assessment decisions for both treatments were publicly available were included in the present analysis. The HTA reports were analyzed broadly for the assessment of clinical and pharmacoeconomic evidence. Only economic models considering both patisiran and inotersen were included in this analysis.

Results: A total of nine agencies with public assessment reports for both treatments were identified. HTA agency assessments for both treatments were essentially positive; however, differences were noted in the final recommendations, place in treatment or reimbursed indications, and in the narrative of the evaluations. Only the Canadian Agency for Drugs and Technologies in Health (CADTH) assessment for patisiran evaluated an economic model comparing the two treatments.

Conclusions: The differences summarized in this comparative analysis may provide a more comprehensive overview of the two treatments.

Downloads

Download data is not yet available.

Author Biography

Sergio Iannazzo, Hetegy, Turin - Italy *

*Affiliation at the time of the study

References

Adams D, Suhr OB, Hund E, et al; European Network for TTR-FAP (ATTReuNET). First European consensus for diagnosis, management, and treatment of transthyretin familial amyloid polyneuropathy. Curr Opin Neurol. 2016;29(suppl 1):S14-S26. https://doi.org/10.1097/WCO.0000000000000289 PMID:26734952

Ando Y, Coelho T, Berk JL, et al. Guideline of transthyretin-related hereditary amyloidosis for clinicians. Orphanet J Rare Dis. 2013;8(1):31. https://doi.org/10.1186/1750-1172-8-31 PMID:23425518

Gertz MA. Hereditary ATTR amyloidosis: burden of illness and diagnostic challenges. Am J Manag Care. 2017;23(7)(suppl):S107-S112. PMID:28978215

Hawkins PNAY, Ando Y, Dispenzeri A, Gonzalez-Duarte A, Adams D, Suhr OB. Evolving landscape in the management of transthyretin amyloidosis. Ann Med. 2015;47(8):625-638. https://doi.org/10.3109/07853890.2015.1068949 PMID:26611723

Carvalho A, Rocha A, Lobato L. Liver transplantation in transthyretin amyloidosis: issues and challenges. Liver Transpl. 2015;21(3):282-292. https://doi.org/10.1002/lt.24058 PMID:25482846

Barroso FAJD, Judge DP, Ebede B, et al. Long-term safety and efficacy of tafamidis for the treatment of hereditary transthyretin amyloid polyneuropathy: results up to 6 years. Amyloid. 2017;24(3):194-204. https://doi.org/10.1080/13506129.2017.1357545 PMID:28758793

Berk JL. TTR Gene silencers for hereditary ATTR amyloidosis: more than ICER recognized. J Manag Care Spec Pharm. 2019;25(1):15-16. https://doi.org/10.18553/jmcp.2019.25.1.015 PMID:30589634

European Medicines Agency. (2018). Onpattro (patisiran). https://www.ema.europa.eu/en/documents/overview/onpattro-epar-medicine-overview_en.pdf. Accessed July 5, 2019.

European Medicines Agency. (2018). Tegsedi (inotersen). https://www.ema.europa.eu/en/documents/overview/tegsedi-epar-summary-public_en.pdf. Accessed July 5, 2019.

Ledford H. Gene-silencing technology gets first drug approval after 20-year wait. Nature. 2018;560(7718):291-292. https://doi.org/10.1038/d41586-018-05867-7 PMID:30108348

U.S. Food & Drug Administration. (2018). Drug Approval Package: Tegsedi (inotersen). U.S. Food & Drug Administration. (2018). Drug Approval Package: Tegsedi (inotersen). https://www.accessdata.fda.gov/drugsatfda_docs/nda/2018/211172Orig1s000TOC.cfm. Accessed July 9, 2019.

National Institute for Health and Care Excellence. NICE Guidance and advice list. https://www.nice.org.uk/guidance/published?type=hst. Accessed September 6, 2019.

European Commission. (2017). Mapping of HTA national organisations, programmes and processes in EU and Norway 1-51. https://op.europa.eu/en/publication-detail/-/publication/971cf96d-0aef-11e8-966a-01aa75ed71a1. Accessed July 9, 2019.

INAHTA. (2019). The International Network of Agencies for Health Technology Assessment. http://www.inahta.org/. Accessed July 8, 2019.

National Institute for Health and Care Excellence. (2019). Final evaluation document: Inotersen for treating hereditary transthyretin-related amyloidosis 1-24. https://www.nice.org.uk/guidance/hst9/documents/final-evaluation-determination-document. Accessed July 9, 2019.

Commission de la transparence. (2019). Avis 20 mars 2019, patisiran 1-21. https://www.has-sante.fr/upload/docs/evamed/CT-17388_ONPATTRO_PIC_INS_Avis3_CT17388.pdf. Accessed July 9, 2019.

Commission de la transparence. (2019). Avis 17 avril 2019, inotersen 1-23. https://www.has-sante.fr/upload/docs/application/pdf/2019-04/tegsedi_pic_ins_avis3_ct17282.pdf. Accessed July 9, 2019.

Gemeinsamer Bundesausschuss. (2019). Tragende Gründe zum Beschluss des Gemeinsamen Bundesausschusses über eine Änderung der Arzneimittel-Richtlinie (AM-RL): Anlage XII—Beschlüsse über die Nutzenbewertung von Arzneimitteln mit neuen Wirkstoffen nach § 35a SGB V—Inotersen 1-14. https://www.g-ba.de/downloads/40-268-5646/2019-03-22_AM-RL-XII_Inotersen_D-381_TrG.pdf. Accessed July 9, 2019.

Gemeinsamer Bundesausschuss. (2019). Tragende Gründe zum Beschluss des Gemeinsamen Bundesausschusses über eine Änderung der Arzneimittel-Richtlinie (AM-RL): Anlage XII—Beschlüsse über die Nutzenbewertung von Arzneimitteln mit neuen Wirkstoffen nach § 35a SGB V—Patisiran 1-15. https://www.has-sante.fr/upload/docs/application/pdf/2019-04/tegsedi_pic_ins_avis3_ct17282.pdf. Accessed July 9, 2019.

National Institute for Health and Care Excellence. (2019). Final evaluation document: Patisiran for treating hereditary transthyretin amyloidosis 1-32. https://www.nice.org.uk/guidance/hst10/documents/html-content-3. Accessed July 9, 2019.

Canadian Agency for Drugs and Technologies in Health. (2019). CADTH Canadian Drug Expert Committee Recommendation. Patisiran (ONPATTRO—Alnylam Netherlands BV). https://www.cadth.ca/sites/default/files/cdr/complete/SR0598%20Onpattro%20-%20CDEC%20Final%20Recommendation%20July%2029%2C%202019%20for%20posting.pdf. Accessed August 5, 2019.

Scottish Medicines Consortium. (2019). SMC Advice on new medicines: patisiran 2mg/mL concentrate for solution for infusion (Onpattro®). https://www.scottishmedicines.org.uk/media/4446/patisiran-onpattro-final-may-2019-for-website.pdf. Accessed July 8, 2019.

Scottish Medicines Consortium. (2019). SMC advice on new medicines: inotersen 284mg solution for injection in pre-filled syringe (Tegsedi®). https://www.scottishmedicines.org.uk/media/4641/inotersen-tegsedi-final-july-2019-amended-080819-for-website.pdf. Accessed August 20, 2019.

Institute for Clinical and economic Review. Inotersen and Patisiran for Hereditary Transthyretin Amyloidosis: Effectiveness and Value (2018) i-153. https://icer.org/wp-content/uploads/2020/10/ICER_Amyloidosis_Final_Evidence_Report_101718.pdf. Accessed July 9, 2019.

Tandvards-OCH Lakemedelsformansverket. (2018). Underlag för beslut i landstingen: Onpattro (patisiran) i-43. https://www.tlv.se/download/18.69c4e1d51687562e1902f812/1548255242342/bes181218_underlag_onpattro.pdf. Accessed July 9, 2019.

Tandvards-OCH Lakemedelsformansverket. (2019). Underlag för beslut i landstingen: Tegsedi (inotersen) i-31. https://www.tlv.se/download/18.4f6b51b816ab7b4b1223dbad/1558078616551/bes190408_underlag_tegsedi.pdf. Accessed July 9, 2019.

The New Therapies Council. Managed introduction—this is how it works. https://www.janusinfo.se/nationelltordnatinforande/managedintroductionthisishowitworks/inenglish/thenewtherapiescouncil.5.4771ab7716298ed82ba9989c.html. Accessed July 26, 2019.

Wenzl M, Paris V. (June 2018). Pharmaceutical reimbursement and pricing in Germany. In OECD (Ed.), 1:22. https://www.oecd.org/health/health-systems/Pharmaceutical-Reimbursement-and-Pricing-in-Germany.pdf. Accessed July 9, 2019.

Haute Autorité de Santé. (2019). Avis d’Efficience. Onpattro (patisiran) Amylose héréditaire à transthyrétine chez les patients adultes atteints de polyneuropathie de stade 1 ou de stade 2. https://www.has-sante.fr/upload/docs/application/pdf/2019-07/onpattro_11062019_avis_efficience.pdf. Accessed July 8, 2019.

Haute Autorité de Santé. (2019). Avis d’Efficience. Tegsedi (inotersen) Amylose à transthyrétine héréditaire chez les patients adultes atteints de polyneuropathie de stade 1 ou de stade 2. https://www.has-sante.fr/upload/docs/application/pdf/2019-07/tegsedi_14052019_avis_efficience.pdf. Accessed July 8, 2019.

Tandvards-OCH Lakemedelsformansverket. (2019). Underlag för beslut i regionerna En samlad bedömning av Onpattro och Tegsedi. https://www.tlv.se/download/18.510e428316b4186c913684bf/1560502194406/samlad_bedomning_onpattro_tegsedi.pdf. Accessed July 8, 2019.

Infarmed Autoridade Nacional do Medicamento e Produtos de Saúde L.P. Relatório público de avalição: ONPATTRO (patisiran) 1–65. https://www.infarmed.pt/documents/15786/1424140/Relat%C3%B3rio+de+avalia%C3%A7%C3%A3o+de+financiamento+p%C3%BAblico+de+Onpattro+%28Patisiran%29+2020/a8252458-bcdb-402b-9a97-b91a6fa81c97. Accessed November 20, 2020.

Infarmed Autoridade Nacional do Medicamento e Produtos de Saúde L.P. Relatório. https://www.infarmed.pt/documents/15786/1424140/Relat%C3%B3rio+de+avalia%C3%A7%C3%A3o+de+financiamento+p%C3%BAblico+de+Tegsedi+%28Inotersen%29+2020/d7c02681-30b9-8a9e-e6ff-ff9460a4e7f3. Accessed November 20, 2020.

Agencia española de medicamentos y productos sanitarios. (2020). Informe de Posicionamiento Terapéutico de patisirán (Onpattro®) en el tratamiento de la amiloidosis hereditaria por transtiretina 1–7. [AUTHOR: Please add link] Accessed November 20, 2020.

Agencia española de medicamentos y productos sanitarios. (2020). Informe de Posicionamiento Terapéutico de inotersén (Tegsedi®) en el tratamiento de la amiloidosis hereditaria por transtiretina 1–9. https://www.aemps.gob.es/medicamentosUsoHumano/informesPublicos/docs/IPT_9-2020-inotersen-Tegsedi.pdf?x42065. Accessed November 20, 2020.

Canadian Agency for Drugs and Technologies in Health. (2019). CADTH Canadian Drug Expert Committee Recommendation: inotersen (TEGSEDI, Akcea Theapeutics, Inc.). https://www.cadth.ca/inotersen. Accessed November 14, 2020.

International Peripheral Nerve Society. Diabetic polyneuropathy in controlled clinical trials: Consensus Report of the Peripheral Nerve Society. Ann Neurol. 1995;38(3):478-482. https://doi.org/10.1002/ana.410380323 PMID:7668839

Published

2021-03-12

How to Cite

Iannazzo, S. (2021). A comparative analysis of international health technology assessments for novel gene silencing therapies: patisiran and inotersen. Global and Regional Health Technology Assessment, 8(1), 14–21. https://doi.org/10.33393/grhta.2021.2193

Issue

Section

Original Research Articles

Categories

Received 2020-10-23
Accepted 2021-02-08
Published 2021-03-12

Metrics