Discussion on cost inputs involved in the cost-efficiency analysis which includes: medication cost, REBYOTA cost, imaging cost, out-patient visit costs, and more.
Dr. Paul Feuerstadt: Within this analysis, the ratio for quality adjusted life years in terms of improvement or benefit of something like RBL [00:24:00] was 0.285. And that's largely where that $18,727 number per quality adjusted life got. So that's your incremental cost effectiveness ratio. And then the one recurrence and beyond, you quoted it before, 13,727. So it's important though to contextualize this as a payer. There's a threshold out there that was novel to me, of $100,000 per quality adjusted life year. Can you put this 18,727 and 13,727, these dollar amounts for multiple recurrences and single recurrence into context with that $100,000 threshold.
Dr. Michael Kobernick: The way we look at it is that if it's- if the- if it exceeds the threshold, then it costs too much for the value that it's bringing. That's how we think about it. But then it's the- this is the challenge because the- there's times at which you think about orphan diseases which have 2 or $300,000 ICER savings or- and we can't- and yet they're really helping one person. And so there's a context to your point. I think that if- this is a good argument if a health plan were to say, this just costs too much, we're not going to cover it. And I don't- or the prior authorization is too restrictive. I don't think that's the case here, but I do think that there's- remains the problem of under- I don't know, and I'm really interested in your perspective on this, the underutilization of the treatment.
Dr. Paul Feuerstadt: So from my standpoint, it was eye-opening from a resource allocation standpoint and a willingness to pay standpoint, which you spoke to. What I really do appreciate is you're saying, look on the payer's side, you know what, we look at the data, we look at the indication and we look at the overall. And analysis like these can nudge, but they don’t necessarily flip the switch.
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