Economic modeling to evaluate the impact of chronic myeloid leukemia therapy management on the oncology care model in the US

Figures & data

Table 1. Cancer types treated in a typical OCM practice and associated all-cause healthcare costs.

Cancer type	Distribution^a (patient count)	All-cause healthcare cost per 6 months	Total all-cause healthcare costs for 6 months (% of cost)
Breast cancer	35.1% (351)	$34,373^12	$12,064,818 (23.5%)
Prostate cancer	12.0% (120)	$29,749^13	$3,569,901 (7.0%)
Lung cancer	9.8% (98)	$83,067^12	$8,140,601 (15.9%)
Lymphoma	7.1% (71)	$43,813^14	$3,110,738 (6.1%)
Colorectal cancer	6.5% (65)	$51,559^12	$3,351,338 (6.5%)
Leukemia non-CML	3.9% (39)	$211,025^15–17 ^b	$8,229,987 (16.0%)
CML	0.4% (4)	$56,277^18	$225,108 (0.4%)
Bladder cancer	2.1% (21)	$19,704^14^,^19	$413,787 (0.8%)
Other cancers	23.1% (231)	$52,985^20^,^21 ^c	$12,239,534 (23.8%)
Total number of cancer patients treated each year	100% (1,000 patients)		$51,345,812

^a The distribution of cancer types treated in a typical OCM was obtained from the first annual CMS report on the OCM³, except for leukemia non-CML and CML, of which distributions were obtained from statistics of the American Cancer Society⁴.

^b Weighted average of reported costs for acute lymphoblastic leukemia¹⁵, chronic lymphocytic leukemia¹⁶, and acute myeloid leukemia¹⁷.

^c Weighted average of reported costs for other cancers^20,21.

All costs were inflation adjusted to 2018 USD.

Abbreviations. OCM, Oncology Care Model; CML, chronic myeloid leukemia.

Figure 1. Changes in TKI market shares due to restrictions of usage of branded TKIs.

Abbreviations. TKI, tyrosine kinase inhibitor; CML, chronic myeloid leukemia.

Table 2. TKI treatment costs of CML patients (newly-diagnosed and established) prior to (baseline episode) and after (future episode) implementing a policy of restricting usage of branded TKIs.

TKI	WAC per 30 days	Baseline episode TKI treated patients	Future episode TKI treated patients	Baseline episode TKI cost	Future episode TKI cost	Cost change (Future – Baseline)
Branded Imatinib	$10,122	0.54	0.11	$32,893	$6,579	−$26,314
Generic Imatinib	$410	2.08	2.68	$5,112	$6,593	$1,481
Dasatinib	$12,912	0.76	0.65	$58,953	$50,388	−$8,565
Nilotinib	$13,644	0.62	0.56	$50,513	$45,692	−$4,821
Total		4	4	$147,470	$109,250	−$38,220

The number of patients treated with each TKI drug and TKI costs are reported for 6-month episodes of care.

Abbreviations. TKI, tyrosine kinase inhibitor; CML, chronic myeloid leukemia.

Table 3. Cost reductions associated with changes in TKI usage relative to the OCM cost reduction threshold requirement for a PBP.

	Net cost change due to TKI drug shift	OCM cost reduction required for a PBP^a	TKI cost change relative to OCM cost reduction threshold required for a PBP
One-sided OCM Risk	−$38,220	−$3,013,832	1.3%
Shift from branded imatinib to generic imatinib	−$25,250		0.8%
Shift from 2^nd-gen TKIs to generic imatinib	−$12,970		0.4%
Two-sided OCM Risk	−$38,220	−$2,372,010	1.6%
Shift from branded imatinib to generic imatinib	−$25,250		1.1%
Shift from 2^nd-gen TKIs to generic imatinib	−$12,970		0.5%

^a The MEOS payment has been reflected in the total cost reduction required to be eligible for a PBP.

Abbreviations. TKI, tyrosine kinase inhibitor; OCM, Oncology Care Model; PBP, performance-based payment.

Table 4. Sensitivity analysis: cost reductions associated with changes in TKI usage relative to the OCM cost reduction threshold requirement for a PBP.

	Net cost change due to TKI drug shift	OCM cost reduction required for a PBP^a	TKI cost change relative to OCM cost reduction threshold required for a PBP
One-sided OCM Risk	−$29,400	−$3,013,832	1.0%
Shift from branded imatinib to generic imatinib	−$25,250		0.8%
Shift from 2^nd-gen TKIs to generic imatinib	−$4,150		0.1%
Two-sided OCM Risk	−$29,400	−$2,372,010	1.2%
Shift from branded imatinib to generic imatinib	−$25,250		1.1%
Shift from 2^nd-gen TKIs to generic imatinib	−$4,150		0.2%

^a The MEOS payment has been reflected in the total cost reduction required to be eligible for a PBP.

Abbreviations. TKI, tyrosine kinase inhibitor; OCM, Oncology Care Model; PBP, performance-based payment.

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