What is the cost of osilodrostat (LCI699) for treating Cushing's disease?

Cost of Osilodrostat for Cushing's Disease Treatment

The cost of osilodrostat (Isturisa) is a significant consideration in treatment planning, with estimates ranging from approximately $11,550 per month based on Group Purchasing Organization (GPO) pricing, or about $72,768 for a 6-month treatment course. 1

Pricing Structure and Options

Osilodrostat pricing varies based on several factors:

• Standard pricing: Approximately $11,550 per month (GPO pricing) 1
• 340B pricing: Approximately $5,222.59 per month (discounted pricing for eligible healthcare organizations) 1
• Medicare pricing: Approximately $12,128 per month 1

Dosing Considerations Affecting Cost

• Starting dose: Typically 2-7 mg/day administered twice daily 2
• Maintenance dose: Individualized based on cortisol levels and tolerability 2
• Maximum dose: Can be titrated up to 30 mg/day in some cases 1

The cost varies proportionally with the dose required, which is important as Asian patients generally require lower doses (median 3.8 mg/day) compared to non-Asian patients (median 7.3 mg/day) 3.

Cost in Context of Treatment Selection

When selecting medical therapy for Cushing's disease, cost is an important consideration:

• Treatment duration: Cost becomes particularly relevant when planning for definitive treatment (surgery or radiotherapy) 1
• Comparative costs: Osilodrostat is generally more expensive than older medications like ketoconazole ($122.24/month GPO) or metyrapone, but may offer higher efficacy 1
• Insurance coverage: Patient out-of-pocket costs vary significantly depending on insurance coverage and pharmacy benefit structure 1

Cost-Effectiveness Considerations

Despite its high cost, several factors may justify osilodrostat use:

• High efficacy rate: 86% of patients maintain normal urinary free cortisol levels versus 29% with placebo 4
• Rapid action: Osilodrostat works quickly, making it valuable for patients requiring rapid cortisol normalization 1
• Clinical improvements: Treatment leads to significant improvements in body weight, blood pressure, cholesterol levels, and quality of life 4

Practical Recommendations for Cost Management

1. Insurance verification: Check coverage before initiating therapy
2. Patient assistance programs: Explore manufacturer programs for eligible patients
3. 340B pricing: Consider treatment at eligible healthcare facilities when possible
4. Dose optimization: Use the lowest effective dose to control symptoms
5. Treatment duration planning: Consider cost implications when planning for definitive treatment 1

Pitfalls to Avoid

• Undertreatment due to cost concerns: Inadequate dosing may lead to persistent hypercortisolism and associated morbidity
• Overlooking drug interactions: Careful assessment of concomitant medications is essential to avoid complications that could increase overall healthcare costs 2
• Ignoring monitoring costs: Regular cortisol level testing, electrolyte monitoring, and ECG assessments add to the overall cost of therapy 2

The high cost of osilodrostat must be weighed against its proven efficacy and potential to improve morbidity, mortality, and quality of life in patients with Cushing's disease, particularly when surgery is not an option or has not been curative.