Targeted erlotinib for first-line treatment of advanced non-small cell lung cancer: a budget impact analysis

Abstract

Objectives:

A recent phase III trial showed that patients with advanced non-small cell lung cancer (NSCLC) whose tumors harbor specific EGFR mutations significantly benefit from first-line treatment with erlotinib compared to chemotherapy. This study sought to estimate the budget impact if coverage for EGFR testing and erlotinib as first-line therapy were provided in a hypothetical 500,000-member managed care plan.

Methods:

The budget impact model was developed from a US health plan perspective to evaluate administration of the EGFR test and treatment with erlotinib for EGFR-positive patients, compared to non-targeted treatment with chemotherapy. The eligible patient population was estimated from age-stratified SEER incidence data. Clinical data were derived from key randomized controlled trials. Costs related to drug, administration, and adverse events were included. Sensitivity analyses were conducted to assess uncertainty.

Results:

In a plan of 500,000 members, it was estimated there would be 91 newly diagnosed advanced NSCLC patients annually; 11 are expected to be EGFR-positive. Based on the testing and treatment assumptions, it was estimated that 3 patients in Scenario 1 and 6 patients in Scenario 2 receive erlotinib. Overall health plan expenditures would increase by $0.013 per member per month (PMPM). This increase is largely attributable to erlotinib drug costs, in part due to lengthened progression-free survival and treatment periods experienced in erlotinib-treated patients. EGFR testing contributes slightly, whereas adverse event costs mitigate the budget impact. The budget impact did not exceed $0.019 PMPM in sensitivity analyses.

Conclusions:

Coverage for targeted first-line erlotinib therapy in NSCLC likely results in a small budget impact for US health plans. The estimated impact may vary by plan, or if second-line or maintenance therapy, dose changes/interruptions, or impact on patients’ quality-of-life were included.

Keywords::

• Budget impact
• Cost
• Erlotinib
• Non-small cell lung cancer

Transparency

Declaration of funding

This study was funded by Genentech, Inc. The authors had full control of the design, analysis, interpretation, and reporting of the study.

Declaration of financial/other relationships

P. Bajaj has served as a consultant for Genentech and the National Pharmaceutical Council. J. Carlson has served as a consultant for Genentech and Life Technologies Inc. D. Veenstra has served as a consultant for Genentech, Abbott Diagnostics, and the National Pharmaceutical Council. H. Goertz is an employee of Genentech Inc. JME Peer Reviewers on this manuscript have no relevant financial or other relationships to disclose.

Notice of Correction

The version of this article published online ahead of print on 12 May 2014 contained an error in the abstract and in the results section on page 543. In the abstract, the sentence “Based on the testing and treatment assumptions, it was estimated that five patients in Scenario 1 and 10 patients in Scenario 2 receive erlotinib” should have read “Based on the testing and treatment assumptions, it was estimated that 3 patients in Scenario 1 and 6 patients in Scenario 2 receive erlotinib”. On page 543, the sentence “Based on the testing and treatment assumptions described, we estimated that five patients are treated with erlotinib in Scenario 1 and 10 patients are treated with erlotinib in Scenario 2 as first-line therapy” should have read “Based on the testing and treatment assumptions described, we estimated that 3 patients are treated with erlotinib in Scenario 1 and 6 patients are treated with erlotinib in Scenario 2 as first-line therapy.” The errors have been corrected for this version.

Since the notice of correction was published on 09 July 2014 a further error has been found on page 541. The sentence “Grades 3 and 4 adverse events occurring in greater than 5.0% of patients were considered and data were derived from the prescribing information and/or pivotal studies for each treatment regime” should have read “Serious or grades 3 and 4 adverse events occurring in greater than 5.0% of patients were considered and data were derived from the prescribing information and/or pivotal study publication for each treatment regimen.” This error has been corrected for this version.