Budget impact of netupitant/palonosetron for the prevention of chemotherapy-induced nausea and vomiting

Figures & data

Table 1. Market share.

Product	HEC		MEC
	Base year	Comparator year	Base year	Comparator year
5-HT3 RA
Palonosetron IV	55.0%	49.5%	55.0%	52.2%
Granisetron IV	0.0%	0.0%	0.0%	0.0%
Granisetron SubQ	0.0%	0.0%	0.0%	0.0%
Ondansetron IV	45.0%	40.5%	45.0%	42.8%
NK1 RA
Fosaprepitant IV	95.0%	85.5%	9.5%	4.8%
Aprepitant PO	5.0%	4.5%	0.5%	0.2%
Rolapitant PO	0.0%	0.0%	0.0%	0.0%
Aprepitant IV	0.0%	0.0%	0.0%	0.0%
Combination 5-HT3/NK1 RA
Netupitant/palonosetron PO	0.0%	10.0%	0.0%	5.0%
Total 5-HT3	100.0%	100.0%	100.0%	100.0%
Total NK1	100.0%	100.0%	10.0%	10.0%

Abbreviations. 5-HT₃, serotonin-3; HEC, highly emetogenic chemotherapy; IV, intravenous; MEC, moderately emetogenic chemotherapy; NK₁, neurokinin-1; PO, oral; RA, receptor antagonist; SubQ, subcutaneous.

Table 2. Prophylaxis cost (2017 USD).

Product	Dose	Cost per dose*	Cost per treatment cycle^a	Plan cost per treated patient^b
5-HT3 RA
Palonosetron IV	0.25 mg	$200.20	$222.81	$1,336.86
Granisetron IV	7.5 mg	$20.10	$42.71	$256.26
Granisetron SubQ	10 mg	$434.40	$457.01	$2,742.06
Ondansetron IV	16 mg	$1.39	$24.00	$144.01
NK1 RA
Fosaprepitant IV	150 mg	$314.70	$337.31	$2,023.86
Aprepitant PO	Tri-Pack	$774.36	$749.46	$4,496.76
Rolapitant PO	180 mg	$595.50	$565.24	$3,391.41
Aprepitant IV	130 mg	$312.70	$335.31	$2,011.86
Combination 5-HT3/NK1 RA
Netupitant/palonosetron PO	1 capsule	$560.00	$528.67	$3,172.02
Steroids
Dexamethasone IV	12 mg/8 mg	$3.50	$26.11	$156.66

^a Incorporates $50 copayment and $1.87 dispensing fee for oral products or $22.61 administration cost for intravenous and subcutaneous products.

^b Assumes six cycles of chemotherapy.

* All costs are as of December 2017.

Abbreviations. 5-HT₃, serotonin-3; IV, intravenous; NK₁, neurokinin-1; PO, oral; RA, receptor antagonist; SubQ, subcutaneous.

Table 3. Prophylaxis regimen-specific CINV event-related medical costs.

Prophylactic regimen^a	CINV event rate/cycle	CINV-related RU^b/cycle	Average CINV medical costs (per treated patient)^c
HEC
PALO IV + FOS IV or APR IV or APR PO	21.5%^21^,^22	16.3%	$1,382
(PALO IV or GRAN SubQ) + ROL PO	29.9%^24	22.7%	$1,922
(OND IV or GRAN IV) + (FOS IV or APR IV or APR PO)	27.0%^19	20.5%	$1,735
OND IV or GRAN IV + ROL PO	29.9%^24	22.7%	$1,922
GRAN SubQ + FOS IV or APR IV	21.5%^23	16.3%	$1,382
NEPA PO	10.4%^25^,^26	7.9%	$668
MEC
PALO IV monotherapy	31.0%^20	10.4%	$882
GRAN SubQ monotherapy	36.7%^23	12.3%	$1,044
OND IV or GRAN IV monotherapy	48.0%^19	16.1%	$1,366

^a All regimens are used in combination with dexamethasone.

^b After adjusting CINV rate per cycle by 76.0% for HEC and 33.6% for MEC, per data on resource use per cycle from Burke et al.⁴

^c Values reflect total costs of CINV events (i.e. not including 5-HT₃ RA or NK₁ RA costs) assuming six cycles per patient.

Abbreviations. APR, aprepitant; CINV, chemotherapy-induced nausea and vomiting; FOS, fosaprepitant; GRAN, granisetron; HEC, highly emetogenic chemotherapy; IV, intravenous; MEC, moderately emetogenic chemotherapy; NEPA, netupitant/palonosetron; OND, ondansetron; PALO, palonosetron; PO, oral; ROL, rolapitant; RU, resource utilization; SubQ, subcutaneous.

Table 4. Data sources and inputs for CINV-related medical event costs.

Source	Data year, USD	Inpatient	Ambulatory	Emergency department	Weighted average cost^a (2017 USD)
Burke et al.^4	2005	$7,448	$1,494	$918	$7,778
Rashid et al.^27	2013	$10,074	$91	$250	$7,329
HCUP and other^28^,^31^,^32	2014	$14,284	$240	$1,233	$10,275

^a Relative frequency of HCRU: Inpatient 64.3%, Ambulatory 25.9%, Emergency department 9.8% (Source: Burke et al.⁴).

Abbreviations. CINV, chemotherapy-induced nausea and vomiting; HCUP, Healthcare Cost and Utilization Project; HCRU, healthcare resource use; USD, United States dollars.

Table 5. Base case results (2017 USD).

Product	Base year	Comparator year	Difference
Drug costs	$3,493,630	$3,518,760	$25,130
CINV medical costs	$15,118,639	$14,532,442	−$586,197
Total costs	$18,612,269	$18,051,202	−$561,067

Abbreviations. CINV, chemotherapy-induced nausea and vomiting; USD, United States dollars.

Figure 1. Per-patient CINV total costs (2017 USD) by CINV prophylaxis regimen, with prophylaxis and CINV medical cost breakout. Abbreviations. APR, aprepitant; CINV, chemotherapy-induced nausea and vomiting; FOS, fosaprepitant; GRAN, granisetron; IV, intravenous; MEC, moderately emetogenic chemotherapy; NEPA, netupitant/palonosetron; OND, ondansetron; PALO, palonosetron; PO, oral; ROL, rolapitant; SubQ, subcutaneous; USD, United States dollars.

Table 6. Per patient costs (2017 USD) by CINV regimen.

Prophylactic regimen	Prophylaxis cost^a	CINV medical cost^a	Total cost^a
5-HT3 RA + dexamethasone
PALO IV monotherapy	$1,494	$5,293	$6,787
GRAN SubQ monotherapy	$2,899	$6,266	$9,165
OND IV monotherapy	$301	$8,196	$8,496
GRAN IV monotherapy	$413	$8,196	$8,609
5-HT3 RA + NK1 RA + dexamethasone
PALO IV + FOS IV	$3,517	$8,292	$11,809
PALO IV + APR PO	$5,990	$8,292	$14,282
PALO IV + ROL PO	$4,885	$11,531	$16,416
PALO IV + APR IV	$3,505	$8,292	$11,797
GRAN SubQ + FOS IV	$4,923	$8,292	$13,214
GRAN SubQ + ROL PO	$6,290	$11,531	$17,822
OND IV + FOS IV	$2,325	$10,413	$12,737
OND IV + APR PO	$4,797	$10,413	$15,210
OND IV + ROL PO	$3,692	$11,531	$15,223
OND IV + APR IV	$2,313	$10,413	$12,725
GRAN IV + FOS IV	$2,437	$10,413	$12,850
GRAN IV + APR PO	$4,910	$10,413	$15,323
GRAN IV + ROL PO	$3,804	$11,531	$15,336
GRAN IV + APR IV	$2,425	$10,413	$12,838
NEPA PO	$3,329	$4,011	$7,340

^a Assumes six cycles of chemotherapy and prophylaxis per patient.

Abbreviations. 5-HT₃, serotonin-3; APR, aprepitant; CINV, chemotherapy-induced nausea and vomiting; FOS, fosaprepitant; GRAN, granisetron; IV, intravenous; NEPA, netupitant/palonosetron; NK₁, neurokinin-1; OND, ondansetron; PALO, palonosetron; PO, oral; RA, receptor antagonist; ROL, rolapitant; SubQ, subcutaneous; USD, United States dollars.

Figure 2. Sensitivity analysis results. Abbreviations. APR, aprepitant; CINV, chemotherapy-induced nausea and vomiting; FOS, fosaprepitant; HEC, highly emetogenic chemotherapy; IV, intravenous; MEC, moderately emetogenic chemotherapy; NEPA, netupitant/palonosetron; NK₁, neurokinin-1; PO, oral.

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