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Katherine B. Winfree
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P10 - Health Services Research/Health Economics - Health Economics (ID 122)
- Event: WCLC 2020
- Type: Posters
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P10.04 - A Budget Impact Analysis for Treatment with Ramucirumab Plus Erlotinib in Metastatic EGFR-Mutated NSCLC in the US (ID 3621)
00:00 - 00:00 | Presenting Author(s): Katherine B. Winfree
- Abstract
Introduction
The FDA approved ramucirumab (RAM) in combination with erlotinib (ERL) in 2020 for first-line treatment of metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 (L858R) mutations. The RELAY phase III trial (NCT02411448) showed a statistically significant improvement in progression-free survival (19.4 months [RAM+ERL] versus 12.4 months [placebo+ERL] p<0.0001).
The objective of this analysis was to estimate the budgetary impact (BI) of introducing RAM+ERL as first-line treatment of metastatic EGFR-mutated NSCLC using the U.S. Commercial payer and Medicare perspectives.
Methods
The BI model estimated the costs of metastatic EGFR-mutated NSCLC, before and after adoption of RAM+ERL in a hypothetical cohort over a 5-year time horizon. Eligible patient population was estimated using U.S. epidemiology data. Clinical data were obtained from randomized clinical trials and U.S. prescribing information, and cost data were obtained from online sources and published literature. Market share (MS) projections were based on market research data.
Annual costs were estimated along with per-member-per-month (PMPM) costs in 2020 U.S. dollars.
Of 1,000,000 hypothetical Commercial health-plan members, 10 patients were eligible for treatment with RAM+ERL (193 from Medicare).
Sensitivity analyses (SA) assessed the effect of model parameters on results.
Results
Overall, 1.50% cost increase was predicted from a total budget of $13,200,820 (Table) with annual cost increases ranging from 1.21%-1.72% over the 5-year period. BI of PMPM cost was estimated to be $0.003-$0.004, and drug acquisition cost was the dominating contributor to the budget with 89.0% ($11,886,858). Results were similar for the Medicare population.
The BIM predicted that RAM+ERL would gain 5.3% ($143,490) of the U.S. Commercial market when it becomes available in Year 1 and increase to 9.2% ($245,982) in Year 5. In the Commercial perspective, 77.9% of the drug costs were predicted to come from osimertinib followed by 6.3% from afatinib and 6.6% from other treatments in Year 5.
Based on one-way SA, the budget was most sensitive to changes in acquisition costs for RAM, osimertinib and patient body weight. When MS for RAM+ERL was assumed to increase by 30% from the base case, the overall BI reduced from 1.50% to 0.72% as RAM+ERL partially replaced regimens such as osimertinib, which has higher treatment costs.
Table: Cost estimates and BI
Conclusion2021
2022
2023
2024
2025
Overall
Total cost without RAM+ERL
$2,640,164
$2,640,164
$2,640,164
$2,640,164
$2,640,164
$13,200,820
Acquisition (1st line)
$2,350,694
$2,350,694
$2,350,694
$2,350,694
$2,350,694
$11,753,472
Administration
$2,028
$2,028
$2,028
$2,028
$2,028
$10,141
Premedications
$64
$64
$64
$64
$64
$322
Follow-up
$59,991
$59,991
$59,991
$59,991
$59,991
$299,957
Adverse events
$16,340
$16,340
$16,340
$16,340
$16,340
$81,698
Hospitalization
$146,811
$146,811
$146,811
$146,811
$146,811
$734,056
Post-progression
$64,235
$64,235
$64,235
$64,235
$64,235
$321,174
Total cost with RAM+ERL
$2,685,599
$2,672,009
$2,680,340
$2,680,340
$2,680,340
$13,398,629
Acquisition (1st line)
$2,385,732
$2,369,502
$2,377,208
$2,377,208
$2,377,208
$11,886,858
Administration
$4,489
$5,850
$6,112
$6,112
$6,112
$28,676
Premedications
$382
$562
$604
$604
$604
$2,755
Follow-up
$63,713
$63,179
$62,909
$62,909
$62,909
$315,619
Adverse events
$17,492
$18,312
$18,377
$18,377
$18,377
$90,935
Hospitalization
$149,613
$150,464
$151,008
$151,008
$151,008
$753,102
Post-progression
$64,178
$64,140
$64,122
$64,122
$64,122
$320,683
Budget impact (%)
$45,435
(1.72%)
$31,845
(1.21%)
$40,176
(1.52%)
$40,176
(1.52%)
$40,176
(1.52%)
$197,809
(1.50%)
Per Member Per Month (PMPM)
Total cost without RAM+ERL
$0.22
$0.22
$0.22
$0.22
$0.22
Total cost with RAM+ERL
$0.22
$0.22
$0.22
$0.22
$0.22
Budget impact
$0.004
$0.003
$0.003
$0.003
$0.003
This analysis predicted a modest U.S. health plan BI of adopting RAM+ERL for first-line treatment of metastatic EGFR-mutated NSCLC. Primary drivers of the BI included drug acquisition cost and forecasted MS.
