Targeted erlotinib for first-line treatment of advanced non-small cell lung cancer: a budget impact analysis
Preeti S Bajaj1, David L Veenstra, Hans-Peter Goertz
1University of Washington, Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy , Seattle, WA 98195 , USA.
Objectives:
A recent phase III trial showed that patients with advanced non-small cell lung cancer (NSCLC) whose tumors harbor specific EGFR mutations significantly benefit from first-line treatment with erlotinib compared to chemotherapy. This study sought to estimate the budget impact if coverage for EGFR testing and erlotinib as first-line therapy were provided in a hypothetical 500,000-member managed care plan.
Methods:
The budget impact model was developed from a US health plan perspective to evaluate administration of the EGFR test and treatment with erlotinib for EGFR-positive patients, compared to non-targeted treatment with chemotherapy. The eligible patient population was estimated from age-stratified SEER incidence data. Clinical data were derived from key randomized controlled trials. Costs related to drug, administration, and adverse events were included. Sensitivity analyses were conducted to assess uncertainty.
Results:
In a plan of 500,000 members, it was estimated there would be 91 newly diagnosed advanced NSCLC patients annually; 11 are expected to be EGFR-positive. Based on the testing and treatment assumptions, it was estimated that 3 patients in Scenario 1 and 6 patients in Scenario 2 receive erlotinib. Overall health plan expenditures would increase by $0.013 per member per month (PMPM). This increase is largely attributable to erlotinib drug costs, in part due to lengthened progression-free survival and treatment periods experienced in erlotinib-treated patients. EGFR testing contributes slightly, whereas adverse event costs mitigate the budget impact. The budget impact did not exceed $0.019 PMPM in sensitivity analyses.
Conclusions:
Coverage for targeted first-line erlotinib therapy in NSCLC likely results in a small budget impact for US health plans. The estimated impact may vary by plan, or if second-line or maintenance therapy, dose changes/interruptions, or impact on patients' quality-of-life were included.
Insights
Providing first-line erlotinib for EGFR-mutated non-small cell lung cancer (NSCLC) shows a minimal budget impact for health plans. This targeted therapy increases costs slightly, mainly due to drug expenses, but offers significant patient benefits.
Area of Science:
- Pharmacoeconomics
- Oncology
- Health Services Research
Background:
- Advanced non-small cell lung cancer (NSCLC) patients with specific EGFR mutations benefit from first-line erlotinib over chemotherapy.
- The economic implications of covering EGFR testing and erlotinib for this patient group require evaluation within managed care settings.
Purpose of the Study:
- To estimate the budget impact of providing first-line EGFR testing and erlotinib coverage in a hypothetical 500,000-member managed care plan.
- To compare the costs of targeted therapy (EGFR testing + erlotinib) versus standard chemotherapy for EGFR-mutated NSCLC.
Main Methods:
- A budget impact model was developed from a US health plan perspective.
- Patient population estimated using SEER incidence data; clinical data from randomized controlled trials.
- Included costs: erlotinib drug, administration, and adverse events; sensitivity analyses performed.
Main Results:
- Estimated 91 advanced NSCLC patients annually in a 500,000-member plan, with 11 being EGFR-positive.
- Overall health plan expenditures increased by an estimated $0.013 per member per month (PMPM).
- Increased costs are primarily from erlotinib drug expenses due to longer progression-free survival; EGFR testing costs were minor.
Conclusions:
- First-line targeted erlotinib therapy for NSCLC is associated with a small budget impact for US health plans.
- Budget impact may vary based on plan specifics, inclusion of second-line/maintenance therapies, or quality-of-life considerations.
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