Budget Impact of the 14-Gene Risk-Score (RS) Assay to Inform Adjuvant Chemotherapy Decisions in Early-Stage Non-Small Cell Lung Cancer (NSCLC)

Abstract

ALK-positive, advanced NSCLC in Argentina. Methods: A budget impact model we developed to evaluate two separate scenarios from a payer's perspective. The model compared scenarios with and without crizotinib. In the crizotinib scenario all patients testing positive for the ALK mutation were given crizotinib. Comparators were platin-containing regimens (ex pemetrexed), platin/pemetrexed, erlotinib/gefitinib, and crizotinib. Epidemiology, market basket, adverse event costs, and drug costs were informed through ten local physician questionnaires and published literature. The survey was administered to oncologists in six different private and public hospitals of varying sizes and locations in Argentina. Costs are in 2013 USD (1 USD = 5.88 ARS). Results: Considering the population of Argentina (42,610,981) and applying age based incidence rates, the number of lung cancer patients was estimated to be 12,139. Of those patients 82.5% were estimated to be have metastatic NSCLC and 74% were likely to be treated, leaving 7,411 treated patients in the model. The estimated one-year cost for treating these patients without crizotinib was estimated to be $205,874,409. In the scenario including crizotinib, 154 patients (market uptake of 2.08%) were taken from other regimens and given crizotinib resulting in an estimated one-year cost of $224,651,145. The incremental total cost between these scenarios was $18,776,736 while the incremental costs per ALK+ patient and per member were $211 and $.04 respectively. These results were robust under standard parameter estimate variations. ConClusions: Adding crizotinib as a treatment option may have an acceptable budget impact under standard practices.