Integrated budget impact model to estimate the impact of introducing selpercatinib as a tumor-agnostic treatment option for patients with RET-altered solid tumors in the US

Figures & data

Figure 1. iBIM framework.

* NSCLC, pancreatic cancer, CRC, MTC, TC, salivary gland cancer, cholangiocarcinoma, gastric cancer, small intestine cancer, ovarian cancer, breast cancer, prostate cancer, xanthogranuloma, melanoma skin cancer, non-melanoma skin cancer, sarcoma, pulmonary carcinosarcoma, carcinoid, carcinoma of unknown primary.

Abbreviations: CRC, colorectal cancer; NSCLC, non-small cell lung cancer; MTC, medullary thyroid cancer; TC, thyroid cancer.

Table 1. Estimated patient population per million.

	Estimated # of patients per million
	Commercial				Medicare
		Treated with selpercatinib in the model				Treated with selpercatinib in the model
Tumor type	With RET-altered tumors	Y1	Y2	Y3	With RET-altered tumors	Y1	Y2	Y3
NSCLC (1 L and 2 L+)	5.84	3.79	4.09	4.38	34.37	22.34	24.06	25.78
MTC (1 L and 2 L+)	1.16	0.76	0.81	0.88	2.73	1.78	1.92	2.05
TC (1 L and 2 L+)	1.34	0.87	0.94	1	3.51	2.28	2.45	2.63
Pancreatic	0.27	0.18	0.19	0.2	1.5	0.97	1.05	1.12
CRC	1.58	1.02	1.1	1.18	6.57	4.27	4.6	4.93
Salivary	0.09	0.06	0.06	0.06	0.38	0.25	0.26	0.28
CCA	0.01	0	0	0	0.03	0.02	0.02	0.03
Gastric	0.05	0.03	0.04	0.04	0.22	0.15	0.16	0.17
Small intestine	0.04	0.02	0.03	0.03	0.17	0.11	0.12	0.12
Ovarian	0.32	0.21	0.23	0.24	1.32	0.86	0.93	0.99
Breast	0.06	0.04	0.04	0.04	0.2	0.13	0.14	0.15
Prostate	0.14	0.09	0.1	0.1	0.66	0.43	0.46	0.5
Xanthogranuloma	0.01	0.01	0.01	0.01	0.01	0.01	0.01	0.01
Melanoma skin	0.01	0	0	0	0.03	0.02	0.02	0.02
Non-melanoma skin	0.02	0.01	0.01	0.01	0.26	0.17	0.18	0.19
Sarcoma	0.03	0.02	0.02	0.02	0.08	0.05	0.06	0.06
Pulmonary Carcinosarcoma	0.37	0.24	0.26	0.28	2.1	1.36	1.47	1.57
Carcinoid	0.27	0.18	0.19	0.2	1.2	0.78	0.84	0.9
Carcinoma of unknown primary	0.09	0.06	0.06	0.06	0.48	0.31	0.34	0.36
Total	11.68	7.59	8.17	8.76	55.82	36.29	39.08	41.87

Patients included are per 1-million-members. 1L and 2 L + are indicated for NSCLC, MTC, and TC. For all other tumor types, the treatment was 2 L+.

Abbreviations: 1L, first-line; 2 L+, second-line and beyond; CCA, cholangiocarcinoma; CRC, colorectal cancer; NSCLC, non-small cell lung cancer; MTC, medullary thyroid cancer; RET, REarranged during Transfection; TC, thyroid cancer.

Figure 2. Incremental costs for commercial and medicare perspectives – all tumor types, base-case.

Figure 3. OWSA, base-case – commercial perspective (Y1).

Abbreviations: 1L, first-line; 2L+, second-line and beyond; CRC, colorectal cancer; NSCLC, non-small cell lung cancer; RET, REarranged during Transfection; Y1, year 1.

Figure 4. OWSA, base-case – Medicare perspective (Y1).

Abbreviations: 1L, first-line; 2L+, second-line and beyond; CRC, colorectal cancer; NSCLC, non-small cell lung cancer; RET, REarranged during Transfection; Y1, year 1.

Table 2. Scenario analyses.

# Patients (per million), Commercial		# Patients (per million), Medicare		Incremental cost ($)	Commercial			Medicare
With RET-altered tumors	Selpercatinib treated	With RET-altered tumors	Selpercatinib treated		Y1	Y2	Y3	Y1	Y2	Y3
Scenario 1: 50% RET testing
5.84	3.79 (Y1); 4.09 (Y2); 4.38 (Y3)	27.91	18.14 (Y1); 19.54 (Y2); 20.93 (Y3)	PMPM	0.036	0.09	0.107	0.185	0.462	0.527
				Total Cost	436,550	1,080,262	1,280,640	2,223,916	5,538,211	6,318,729
Scenario 2: GI tumor-specific
1.94	1.26 (Y1); 1.36 (Y2); 1.46 (Y3)	8.49	5.52 (Y1); 5.94 (Y2); 6.37 (Y3)	PMPM	0.013	0.014	0.015	0.062	0.067	0.072
				Total Cost	156,492	168,530	180,568	748,268	805,827	863,386

All values are presented in terms of 2022$. Incremental Cost: cost with selpercatinib – cost without selpercatinib.

GI-tumors included: pancreatic cancer, CRC, CCA, gastric cancer, and small intestine cancer.

Abbreviations: GI, gastrointestinal; PMPM, per-member per-month; RET, REarranged during Transfection; Y, year.

Data sharing statement

The integrated budget impact model could be available to health care decision makers, healthcare organizations, and third party payers by contacting The Lilly Answers Center at 1-800-LillyRx (1-800-545-5979).