Lin Shih-Wen, Shapouri Sheila, Parisé Hélène, Bercaw Eric, Wu Mei, Kim Eunice, Matasar Matthew
Genentech, Inc., South San Francisco, CA, USA.
Medicus Economics, LLC, Milton, MA, USA.
Pharmacoeconomics. 2024 May;42(5):569-582. doi: 10.1007/s40273-024-01358-y. Epub 2024 Feb 1.
OBJECTIVE: This study aimed to assess the budget impact of introducing fixed-duration mosunetuzumab as a treatment option for adult patients with relapsed or refractory follicular lymphoma after at least two prior systemic therapies and to estimate the total cumulative costs per patient in the USA. METHODS: A 3-year budget impact model was developed for a hypothetical 1-million-member cohort enrolled in a mixed commercial/Medicare health plan. Comparators were: axicabtagene ciloleucel, tisagenlecleucel, tazemetostat, rituximab plus lenalidomide, copanlisib, and older therapies (rituximab or obinutuzumab ± chemotherapy). Costs per patient comprised treatment-associated costs including the drug, its administration, adverse events, and routine care. Dosing and safety data were ascertained from respective package inserts and clinical trial data. Drug costs (March 2023) were estimated based on the average wholesale acquisition cost reported in AnalySource, and all other costs were based on published sources and inflated to 2022 US dollars. Market shares were obtained from Genentech internal projections and expert opinion. Budget impact outcomes were presented on a per-member per-month basis. RESULTS: Compared with a scenario without mosunetuzumab, its introduction over 3 years resulted in a budget increase of $69,812 (1% increase) and an average per-member per-month budget impact of $0.0019. Among the newer therapies, mosunetuzumab had the second-lowest cumulative per patient cost (mosunetuzumab = $202,039; axicabtagene ciloleucel = $505,845; tisagenlecleucel = $476,293; rituximab plus lenalidomide = $263,520; tazemetostat = $250,665; copanlisib = $127,293) and drug costs, and its introduction only increased total drug costs by 0.1%. By year 3, the cumulative difference in the per patient cost with mosunetuzumab was -$303,805 versus axicabtagene ciloleucel, -$274,254 versus tisagenlecleucel, -$61,481 versus rituximab plus lenalidomide, -$48,625 versus tazemetostat, and $74,747 versus copanlisib. Older therapies were less costly with 3-year cumulative costs that ranged from $36,512 to $147,885. CONCLUSIONS: Over 3 years, the estimated cumulative per patient cost of mosunetuzumab is lower than most available newer therapies, resulting in a small increase in the budget after its formulary adoption for the treatment of relapsed or refractory follicular lymphoma.
目的：本研究旨在评估引入固定疗程的莫苏奈妥珠单抗作为至少接受过两种先前全身治疗的复发或难治性滤泡性淋巴瘤成年患者的治疗选择所产生的预算影响，并估算美国每位患者的总累积成本。 方法：针对参加混合商业/医疗保险健康计划的100万成员的假设队列，开发了一个为期3年的预算影响模型。比较对象为：阿基仑赛、替雷利珠单抗、他泽司他、利妥昔单抗联合来那度胺、库潘尼西以及较旧的治疗方法（利妥昔单抗或奥妥珠单抗±化疗）。每位患者的成本包括与治疗相关的成本，包括药物、给药、不良事件和常规护理。给药和安全性数据从各自的药品说明书和临床试验数据中确定。药物成本（2023年3月）基于AnalySource报告的平均批发采购成本估算，所有其他成本基于已发表的来源并折算为2022年美元。市场份额来自基因泰克的内部预测和专家意见。预算影响结果以每月每位成员为基础呈现。 结果：与没有莫苏奈妥珠单抗的情况相比，在3年内引入该药物导致预算增加69,812美元（增加1%），平均每月每位成员的预算影响为0.0019美元。在较新的治疗方法中，莫苏奈妥珠单抗的每位患者累积成本第二低（莫苏奈妥珠单抗 = 202,039美元；阿基仑赛 = 505,845美元；替雷利珠单抗 = 476,293美元；利妥昔单抗联合来那度胺 = 263,520美元；他泽司他 = 250,665美元；库潘尼西 = 127,293美元）和药物成本，引入该药物仅使总药物成本增加0.1%。到第3年，使用莫苏奈妥珠单抗的每位患者成本与阿基仑赛相比累积差异为 -303,805美元，与替雷利珠单抗相比为 -274,254美元，与利妥昔单抗联合来那度胺相比为 -61,481美元，与他泽司他相比为 -48,625美元，与库潘尼西相比为74,747美元。较旧的治疗方法成本较低，3年累积成本在36,512美元至147,885美元之间。 结论：在3年期间，莫苏奈妥珠单抗估计的每位患者累积成本低于大多数现有的较新治疗方法，在其被纳入治疗复发或难治性滤泡性淋巴瘤的处方集后，导致预算小幅增加。
J Manag Care Spec Pharm. 2021-5
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