Evaluation of Erlotinib in Advanced Non-Small Cell Lung Cancer: Impact on the Budget of a U.S. Health Insurance Plan

Abstract

BACKGROUND: Lung cancer is the most common non-skin cancer and the leading cause of cancer death among men and women in North America. More than half of all patients diagnosed with lung cancer are diagnosed with advanced disease. Most cases of lung cancer are non-small cell lung cancer (NSCLC). Erlotinib monotherapy is indicated for the treatment of patients with locally advanced or metastatic NSCLC after failure of at least 1 prior chemotherapy regimen.OBJECTIVE: To assess the budgetary impact, from the health plan perspective, of covering erlotinib for treating patients with NSCLC stage IIIb/IV who have failed at least 1 prior chemotherapy regimen.METHODS: An Excel-based model was developed to evaluate costs for U.S. Food and Drug Administration-approved and National Comprehensive Cancer Network guideline-recommended treatment options for second-and third-line NSCLC from the perspective of a U.S. health insurer. In particular, the model compares a formulary with erlotinib and a formulary without erlotinib, including the costs of treatment, drug administration, and adverse effects. The incidence of advanced NSCLC is based on the Surveillance, Epidemiology, and End Results Cancer Registry and adverse effects related to treatment (all agents) in published results of clinical trials. Drug and treatment costs were obtained from publicly available sources in 2005.RESULTS: The base case considers a health plan of 500,000 enrollees. Assuming that erlotinib comprises 30% of second-line treatments and 90% for third-line, total costs of treating stage IIIb/IV NSCLC patients over 1 year are $382,418 with erlotinib and $380,968 without erlotinib (difference: $1,450; 90% confidence interval, -$61,376 to $29,855), less than $0.01 per member per month (PMPM) in 2005. Erlotinib direct cost is offset by reductions in standard chemotherapy-related infusion costs and adverse events.CONCLUSIONS: Based on the analysis, the inclusion of erlotinib on a formulary appears to have a relatively small impact on the annual health care budget or PMPM expenditures if it is used consistent with the product label indications.

Budgetary Impact on a U.S. Health Plan Adopting Abiraterone Acetate Plus Prednisone for the Treatment of Patients with Metastatic Castration-Resistant Prostate Cancer

“…Furthermore, adding erlotinib as a treatment option for second-and third-line treatment of advanced non-small cell lung cancer, where erlotinib was assumed to account for 30% of second-line treatment and 90% of thirdline treatment, resulted in an incremental cost PMPM of less than $0.010. 39 Similar to our analysis, the small incremental cost PMPM was driven by lower administration costs and lower costs of treating adverse events in the group of patients receiving erlotinib. The uptake of erlotinib was more similar to the base case uptake we assumed for abiraterone-8% in scenario 1 to 55% in scenario 3-and abiraterone resulted in a lower PMPM cost.…”

Pharmacy Benefit Spending on Oral Chemotherapy Drugs

“…30 The estimated budget impact of $0.01 per member per month in a hypothetical health plan of 500,000 members could be consequential in a small employer health plan of 500 members, particularly if the pharmacy benefit is self-insured. Second, 5 new FDA approvals for high-cost oral chemotherapy drugs in 7 months through June 30, 2006, creates the need for descriptive, benchmark analysis of the actual direct pharmacy benefit costs for oral chemotherapy drugs.…”

“…The matter of financial budget impact on a large health plan was posed by Ramsey et al in mid-2006. 30 The authors used a pharmacoeconomic model to predict the budget impact of erlotinib on a hypothetical third-party payer with 500,000 enrolled members. When used according to the FDA-approved label indications as second-line or third-line therapy for NSCLC, they estimated that the incremental cost of placing erlotinib on the drug formulary would be less than $0.01 PMPM.…”

Methylated +58CpG site decreases DCN mRNA expression and enhances TGF-β/Smad signaling in NSCLC cells with high metastatic potential

“…Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers. More than 50% of all patients diagnosed with lung cancer have advanced disease (2). Despite improvement in cancer treatment, the prognosis for NSCLC patients is still poor, with 5-year survival rate of approximately 10% (3).…”