This study was funded by Eli Lilly and Company. Molife, Brown, Tawney, and Cuyun Carter are equity holders and employees of Eli Lilly and Company. Bly, Cinfio, and Klein are employees of Medical Decision Modeling, which received funding from Eli Lilly and Company to conduct this research and prepare this manuscript.

Background:The cost of cancer care is increasing, and tools are needed to understand the economic impact of new drugs on the hospital pharmacy budget. Objective: To develop an interactive budget impact model (BIM) through a collaborative effort of industry, academia, and modeling experts to evaluate the use of a new agent in non-small cell lung cancer (NSCLC); this BIM included an institutional module specific to the needs of practices that purchase medications for use in institutional settings. Methods: Treatment regimens, doses, duration of therapy, toxicity, and cost data are from published sources. All input data may be modified to match the local population. Outputs include cost of care, reimbursement, and margin overall and by treatment regimen. Results: The base case assumes 20 NSCLC patients progressing after initial therapy (3 receiving ramucirumab+docetaxel, 2 bevacizumab+erlotinib, 3 docetaxel, 6 erlotinib, and 6 pemetrexed), wholesale acquisition cost (WAC) purchase price, and reimbursement at WAC+4.3%. The model estimated the total cost and reimbursement for the institutional oncology pharmacy to be $699,413 and $729,487, respectively, resulting in a margin of $30,075 (difference due to rounding) for the year for regimens utilized in the treatment of NSCLC in the post-progression setting. Results will vary depending on the input data. Conclusions: There is an increasing need for institutional pharmacies to plan ahead and anticipate the impact of new drugs on their oncology budgets. This interactive Excel-based institutional BIM may provide evidence-based support for pharmacy decision making.

Aim: Estimate budget impact of adopting lesinurad as add-on to allopurinol for urate-lowering therapy in gout. Methods: A budget impact model was developed for a US payer perspective, using a Markov model to estimate costs, survival and discontinuation in a one-million-member health plan. The population included patients failing first-line gout therapy, followed for 5 years. Results: Incremental costs of adding lesinurad versus no lesinurad were US$241,907 and US$1,098,220 in first and fifth years, respectively. Cumulative 5-year incremental cost was US$3,633,440. Estimated incremental mean cost per treated patient with gout per year was US$112. The mean per-member per-month cost increased by US$0.06. Conclusion: Initiating lesinurad would result in an incremental per-member per-month cost of US$0.06 over 5 years. Gout is the most common type of inflammatory arthritis in adults, affecting approximately eight million people in the USA [1]. Gout occurs when serum uric acid (sUA) supersaturates in the serum and begins to precipitate as monosodium urate crystal deposits in the joints, tendons and other soft tissues [2][3][4][5]. Hyperuricemia, defined as an sUA level above 6.8 mg/dl, can be asymptomatic, but the shedding of urate crystals into the joint space may cause joint inflammation and severe pain known as gout flares or gouty arthritis [6]. Severe cases of gout may result in the development of tophi, which are deposits of monosodium urate crystals [7]. Moreover, hyperuricemia is associated with cardiovascular [8][9][10][11] and renal morbidity [12] and an increased risk of mortality [13,14].In 2010, gout was responsible for 2.3% of 38.6 million hospitalizations and approximately five million ambulatory care visits [15]. Patients with gout incur greater direct and indirect costs compared with those without gout [16]. The total all-cause cost of care for US patients with gout is estimated to be US$11,663 per person or US$31.8 billion overall, while the cost of gout-attributable expenses is estimated to be US$2805 per person or US$7.7 billion overall [17]. Another published analysis found the incremental annual cost of care for a gout patient to exceed US$3000 compared with nongouty individuals [18]. Available data show that the costs (total, medical and pharmacy costs) of care associated with uncontrolled gout are substantial and increase with disease severity (defined as higher sUA levels, greater frequency of flares or tophaceous gout) [16,19]. Gout is also associated with poor health-related quality of life, even adjusting for comorbidities [20].The current standard of care for gout includes patient education on diet, lifestyle, treatment objectives, medication adherence and management of comorbidities. Xanthine oxidase inhibitor (XOI) therapy with allopurinol or febuxostat is indicated as the first-line pharmacologic urate-lowering therapy (ULT) to aid patients in achieving an sUA target of <6 mg/dl [21]. Allopurinol, a purine analog, has been the dominant ULT in the USA since 1966 and febuxostat is a nonpu...

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