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

Abstract

Objective

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 (RET)-altered solid tumors.

Methods

An integrated budget impact model (iBIM) with 3-year (Y) time horizon was developed for 19 RET-altered tumors. It is referred to as an integrated 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 RET-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.

Results

Commercial perspective estimated 11.68 patients/million with RET-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 RET-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 RET, and treatment duration as significant drivers of incremental costs.

Conclusions

Three-year incremental PMPM cost estimates suggest a modest impact on payer-budgets associated with introduction of tumor-agnostic selpercatinib treatment.

Keywords:

• Budget impact
• commercial
• Medicare
• non-small cell lung cancer
• RET-altered tumors
• selpercatinib
• thyroid cancer
• tumor-agnostic

JEL CLASSIFICATION CODES:

• I10
• I1
• I
• I11

Transparency

Declaration of funding

Medical Decision Modeling Inc. received funding from Eli Lilly and Company to conduct the study.

Declaration of financial/other relationships

NRB, AMG, and AAA are employees and minor stockholders at Eli Lilly and Company. JM and LS are employees of Medical Decision Modeling Inc., which was contracted by Eli Lilly and Company to perform the analysis.

Author contributions

Conception of work: NRB, JM, AAA LS. Design of work: NRB, AMG, JM, LS. Acquisition of data: JM, LS. Data Analysis: JM, LS. Data interpretation: NRB, AMG, JM, AAA, LS. Manuscript writing and critical revision: NRB, AMG, JM, AAA, LS. Final approval: NRB, AMG, JM, AAA, LS.

Acknowledgements

The authors would like to acknowledge Frank Cinfio, a former employee of Medical Decision Modeling Inc., for his contributions in model development. The authors would also like to acknowledge Karan Sharma from Eli Lilly Services India Private Limited for his medical writing and editorial assistance during the preparation of this manuscript.

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).

Disclosure statement

Naleen Raj Bhandari, Adrienne M. Gilligan, and Amine Ale-Ali are employees and minor stockholders at Eli Lilly and Company. Julie Myers and Lee Smolen are employees of Medical Decision Modeling Inc., which was contracted by Eli Lilly and Company to perform the analysis.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethics approval

This iBIM was exempt from institutional review board approval as it did not include patients directly.

Consent to participate

Due to the nature of the study, consent to participate from patients was not required.

Consent to publication

The manuscript does not contain any individual person’s data in any form. Therefore, consent for publication was not required.

Previous presentation

The abstract and poster were presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR); Boston, MA; 7–10 May 2023 (Poster ID EE507).