Eli Lilly and Company, Indianapolis, IN, USA.
Medical Decision Modeling Inc, Indianapolis, IN, USA.
J Med Econ. 2024 Jan-Dec;27(1):348-358. doi: 10.1080/13696998.2024.2317120. Epub 2024 Mar 6.
To estimate the potential budget impact on US third party payers (commercial or Medicare) associated with addition of selpercatinib as a tumor-agnostic treatment for patients with Rearranged during Transfection ()-altered solid tumors.
An budget impact model (iBIM) with 3-year (Y) time horizon was developed for 19 -altered tumors. It is referred to as an model because it is a single model that integrated results across multiple tumor types (as opposed to tumor-specific models developed traditionally). The model estimated eligible patient populations and included tumor-specific comparator treatments for each tumor type. Estimated annual total costs (2022USD, $) included costs of drug, administration, supportive care, and toxicity. For a one-million-member plan, the number of patients with -altered tumors eligible for treatment, incremental total costs, and incremental per-member per-month (PMPM) costs associated with introduction of selpercatinib treatment were estimated. Uncertainty associated with model parameters was assessed using various sensitivity analyses.
Commercial perspective estimated 11.68 patients/million with -altered tumors as treatment-eligible annually, of which 7.59 (Y1), 8.17 (Y2), and 8.76 (Y3) patients would be selpercatinib-treated (based on forecasted market share). The associated incremental total and PMPM costs (commercial) were estimated to be: $873,099 and $0.073 (Y1), $2,160,525 and $0.180 (Y2), and $2,561,281 and $0.213 (Y3), respectively. The Medicare perspective estimated 55.82 patients/million with -altered tumors as treatment-eligible annually, of which 36.29 (Y1), 39.08 (Y2), and 41.87 (Y3) patients would be selpercatinib-treated. The associated incremental total and PMPM costs (Medicare) were estimated to be: $4,447,832 and $0.371 (Y1), $11,076,422 and $0.923 (Y2), and $12,637,458 and $1.053 (Y3), respectively. One-way sensitivity analyses across both perspectives identified drug costs, selpercatinib market share, incidence of , and treatment duration as significant drivers of incremental costs.
Three-year incremental PMPM cost estimates suggest a modest impact on payer-budgets associated with introduction of tumor-agnostic selpercatinib treatment.
评估将 Selpercatinib 作为一种肿瘤不可知的治疗方法添加到经转染重排（）改变的实体瘤患者中，对美国第三方支付者（商业或医疗保险）的潜在预算影响。
开发了一个为期 3 年（Y）的预算影响模型（iBIM），用于 19 种 -改变的肿瘤。它被称为 -模型，因为它是一个集成了多种肿瘤类型结果的单一模型（与传统开发的肿瘤特异性模型相反）。该模型估计了合格的患者人群，并为每种肿瘤类型纳入了肿瘤特异性对照治疗。估计的年度总费用（2022 美元，$）包括药物、管理、支持性护理和毒性的费用。对于一个拥有一百万成员的计划，估计了 -改变的肿瘤中符合治疗条件的患者人数、增量总成本以及引入 Selpercatinib 治疗的每个成员每月的增量成本（PMPM）。使用各种敏感性分析评估了模型参数的不确定性。
商业视角估计每年有 1168 名患有 -改变的肿瘤的患者有资格接受治疗，其中 759 名（Y1）、817 名（Y2）和 876 名（Y3）患者将接受 Selpercatinib 治疗（基于预测的市场份额）。商业方面的相关增量总成本和 PMPM 成本估计分别为：$873099 和 0.073（Y1）、$2160525 和 0.180（Y2）以及$2561281 和 0.213（Y3）。医疗保险视角估计每年有 5582 名患有 -改变的肿瘤的患者有资格接受治疗，其中 3629 名（Y1）、3908 名（Y2）和 4187 名（Y3）患者将接受 Selpercatinib 治疗。医疗保险方面的相关增量总成本和 PMPM 成本估计分别为：$4447832 和 0.371（Y1）、$11076422 和 0.923（Y2）以及$12637458 和 1.053（Y3）。两个视角的单向敏感性分析确定药物成本、Selpercatinib 市场份额、发病率和治疗持续时间是增量成本的重要驱动因素。
三年的增量 PMPM 成本估计表明，引入肿瘤不可知的 Selpercatinib 治疗对支付者预算的影响不大。
