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

Figures & data

Figure 1. Model schematic. *EGFR negative patients are not followed in the model as their outcomes are not differential between scenarios.

Table 1. Advanced NSCLC patient population estimation.

	Health plan age and gender distribution	Number of patients by age and gender in health plan	Incidence of advanced NSCLC (per 100,000 persons)	Expected annual new advanced NSCLC patients
				All patients	Treatment eligible: EGFR+, Squamous	Treatment eligible: EGFR+, Non-Squamous
Men
≤44 years	33.85%	169,259	1.02	1.73	0.01	0.20
45–54 years	7.85%	39,244	23.03	9.04	0.06	1.06
55–64 years	6.54%	32,719	77.60	25.39	0.17	2.97
65+ years	1.60%	7995	208.33	16.66	0.11	1.95
Women
≤44 years	32.95%	164,764	1.01	1.66	0.01	0.19
45–54 years	8.09%	40,455	17.48	7.07	0.05	0.83
55–64 years	7.02%	35,117	49.48	17.38	0.11	2.03
65+ years	2.09%	10,449	120.34	12.57	0.08	1.47
Total	100.0%	500,000	17.89	91.50	0.60	10.70
Total expected annual treatment eligible patients						11.3

Note: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence − SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2012 Sub (2000–2010) <Katrina/Rita Population Adjustment>, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2013, based on the November 2012 submission. The incidence rates are calculated from the crude incidence rates and reported for the following age groups: ≤44, 45–54, 55–64, and 65+ years. This model consists of advanced-staged NSCLC, which is defined as stage IIIB–IV. The ICD-O-3 codes for non-small cell (8000–8040, 8046–8245, and 8247–9989) are derived by excluding the codes for small cell (8041–8045, 8246) from all the ICD-O-3 codes5^,25.

Table 2. Treatment costs and market share by therapy.

	Erlotinib	Paclitaxel + Carboplatin		Bevacizumab + Paclitaxel + Carboplatin			Pemetrexed + Carboplatin		Bevacizumab + Pemetrexed + Carboplatin
Type of administration	Oral	Infusion	Infusion	Infusion	Infusion	Infusion	Infusion	Infusion	Infusion	Infusion	Infusion
Treatment duration	10.4 months	2.8 months		4.2 months	3.5 months		3.1 months		4.2 months
Treatment interval	Daily	3 weeks		3 weeks			3 weeks		3 weeks
Drug costs
Dose per administration	150 mg	200 mg/m^2	6 mg/ml  × min	15 mg/kg	200 mg/m^2	6 mg/ml  × min	500 mg/m^2	6 mg/ml  × min	15 mg/kg	500 mg/m^2	6 mg/ml  × min
Avg. body mass or surface area	N/A	1.89 m^2	N/A	65.3 kg	1.89 m^2	N/A	1.89 m^2	N/A	65.3 kg	1.89 m^2	N/A
Avg. single administered dose^a–c	150 mg	378 mg	315 mg	980 mg	378 mg	315 mg	945 mg	315 mg	980 mg	945 mg	315 mg
Wholesale acquisition cost^d	$5,751.88	$1.65	$3.20	$152.22	$1.65	$3.20	$579.50	$3.20	$152.22	$579.50	$3.20
mg per unit (tablet/vial)	150 mg	6 mg	10 mg	25 mg	6 mg	10 mg	100 mg	10 mg	25 mg	100 mg	3 mg
Total drug cost^e	$63,270.68	$525.81	$517.97	$43,154.37	$631.28	$621.87	$31,832.83	$562.50	$42,911.54	$40,840.95	$2,232.69
Administration costs
Administration time (hours)	N/A	3.00 hours	0.50 hours	1.25 hours	3.00 hours	0.50 hours	0.17 hours	0.50 hours	1.25 hours	0.17 hours	0.50 hours
Administration fee^f	$142.90	$204.48	$143.24	$173.86	$204.48	$143.24	$143.24	$143.24	$173.86	$143.24	$143.24
Total administration cost	$142.90	$1034.33	$724.56	$1232.23	$1241.79	$869.88	$786.84	$786.84	$1225.30	$1009.50	$1009.50
Total treatment cost	$63,414	$2803		$47,751			$33,969		$89,229
Market share distribution of treatments
Squamous EGFR+: Scenario 1	45%	55%		N/A			N/A		N/A
Squamous EGFR+: Scenario 2	90%	10%		N/A			N/A		N/A
Non-Squamous EGFR+: Scenario 1	45%	13.2%		19.8%			14.9%		7.2%
Non-Squamous EGFR+: Scenario 2	90%	2.4%		3.6%			2.7%		1.3%

^aAverage single administered dose for paclitaxel and pemetrexed is based on patients’ body surface area.

^bAverage single administered dose for carboplatin is calculated using the Calvert formula with a target area under the curve (AUC) of 6.0 mg/mL × min. The Calvert formula is: (Target AUC) × (glomerular filtration rate + 25). The glomerular filtration rate (GFR) was calculated using the Cockrof-Gault formula: (140-age)/(72 × serum creatinine).

^cAverage single administered dose for bevacizumab is based on patients’ body mass.

^dWholesale acquisition cost is based on a 30-day supply of erlotinib and individual vials of infusion therapies.

^eTotal drug cost assumes administration of drug in 30-day packs for erlotinib and whole vials for infusion therapies, thereby accounting for drug wastage.

^fAdministration fee includes a one-time office visit for patients receiving erlotinib ($142.90), and IV administration fee for infusion therapies ($143.24 for first hour and $30.62 for each additional hour), based on the 2013 Medicare Physician Fee Schedule.

Table 3. Detailed results: squamous and non-squamous histologies.

	Scenario 1: 50% EGFR testing rate	Scenario 2: 100% EGFR testing rate	Change in total costs	Change in total costs per member per month (PMPM)
Squamous histology
EGFR mutation testing costs	$2223	$4447	$2223	$0.000
Erlotinib	$9566	$19,132	$9566	$0.002
Treatment costs	$9305	$18,611	$9305	$0.002
Adverse event costs	$261	$522	$261	$0.000
Paclitaxel + Carboplatin	$1239	$225	−$1014	$0.000
Treatment costs	$503	$91	−$411	$0.000
Adverse event costs	$737	$134	−$603	$0.000
Total costs: Squamous histology	$13,029	$23,804	$10,776	$0.002
Non-squamous histology
EGFR mutation testing costs	$8070	$16,140	$8070	$0.001
Erlotinib	$173,608	$347,216	$173,608	$0.029
Treatment costs	$168,874	$337,748	$168,874	$0.028
Adverse event costs	$4734	$9468	$4734	$0.001
Bevacizumab + Pemetrexed + Carboplatin	$38,899	$7073	−$31,827	−$0.005
Treatment costs	$37,756	$6865	−$30,891	−$0.005
Adverse event costs	$1144	$208	−$936	$0.000
Pemetrexed + Carboplatin	$33,965	$6175	−$27,789	−$0.005
Treatment costs	$29,852	$5428	−$24,425	−$0.004
Adverse event costs	$4112	$748	−$3365	−$0.001
Bevacizumab + Paclitaxel + Carboplatin	$64,372	$11,704	−$52,668	−$0.009
Treatment costs	$55,952	$10,173	−$45,779	−$0.008
Adverse event costs	$8419	$1531	−$6888	−$0.001
Paclitaxel + Carboplatin	$5481	$997	−$4485	−$0.001
Treatment costs	$2189	$398	−$1791	$0.000
Adverse event costs	$3292	$599	−$2694	$0.000
Total costs: Non-squamous histology	$324,395	$389,304	$64,909	$0.011
Combined results
EGFR mutation testing costs	$10,293	$20,586	$10,293	$0.002
Treatment costs	$304,431	$379,313	$74,882	$0.012
Adverse event costs	$22,699	$13,209	−$9490	−$0.002
Total costs	$337,424	$413,108	$75,685	$0.013

Figure 2. Sensitivity analysis for budget impact model.

SEER*Stat Database: Incidence - SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2012 Sub (2000–2010) <Katrina/Rita Population Adjustment>. National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch; 2013. Accessed April 2013

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