<p>Budget Impact Of Including Avelumab As A Second-Line Treatment For Locally Advanced Or Metastatic Urothelial Cancer In The United States: Commercial And Medicare Payer Perspectives</p>

Abstract

ObjectiveTo estimate the budget impact of introducing avelumab as a second-line (2L) treatment option for patients with locally advanced or metastatic urothelial cancer (mUC) from the perspective of a US third-party payer (commercial and Medicare).MethodsA budget impact model (BIM) with a three-year time horizon was developed for avelumab. Efficacy and safety data were sourced from published literature and US package inserts. The analysis was conducted in collaboration with a specialist oncologist who validated clinical assumptions. Costs were based on the number of eligible patients, time-to-treatment failure, overall survival, adverse events (AEs), and projected market shares of various treatments.ResultsIn a hypothetical commercial health plan of 30,000,000 members, 884 patients were estimated to be eligible for 2L treatment over a three-year time period. Without avelumab, the total cost for treating patients with mUC was estimated to be US$70,268,035. The introduction of avelumab increased total costs by $73,438 (0.10% increase). In a hypothetical Medicare health plan of 30,000,000 beneficiaries, a total of 4,705 patients were estimated to be eligible for 2L treatment. Without avelumab, the total cost for treating patients with mUC was estimated to be $292,923,098 from a Medicare perspective; however, with avelumab, there was an increase of $719,324 (0.25% increase) in total costs. Results of the sensitivity analyses demonstrated a cost-neutral impact across all tested scenarios from both perspectives.ConclusionThe BIM estimated that avelumab would have a cost-neutral impact within a US commercial and a Medicare health plan. Overall, avelumab can be an affordable and valuable treatment option for patients with locally advanced or mUC in the 2L setting. These findings demonstrate a consistently favorable budget impact in both populations. Further studies should be conducted to more comprehensively assess the clinical and economic implications of adding avelumab to the treatment armamentarium of 2L mUC.

Is the Scope of Costs Considered in Budget Impact Analyses for Anticancer Drugs Rational? A Systematic Review and Comparative Study

“…Regarding the budget-holder perspective, one study calculated the budget impact from the hospital perspective (66), five adopted the health-plan perspective (45,46,48,55,64), and 16 adopted the third-party payer perspective including public health insurance, Medicare, and commercial insurance (42-44, 47-54, 56, 58, 59, 61, 65, 68). Five studies reported results from more than one perspective (43,50,54,58,68).…”

“…Of those, in five studies (14%), the authors took subsequent treatment costs based on guideline recommendations into account, while in the other six studies (24%), the authors took the subsequent treatment costs based on their own model structure and relative considerations into account. For example, Kongnakorn et al(50) calculated the costs of post-progression (on subsequent 3 line active treatment) and post-progression/off-treatment (best supportive care) as subsequent treatment costs, while Stellato et al (52) developed a Markov model and considered the costs of subsequent recurrence events in patients. Bly et al(54) andMistry et al (…”

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“…Avelumab has been studied and deemed that its use would have a cost-neutral impact within a US commercial and a Medicare health plan [ 87 ]. Based on that it is the lowest priced drug on the list ( Table 3 ), and the positive data from the phase III JAVELIN Bladder 100 trial, avelumab is a relatively affordable and a cost-effective option.…”

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“…Regarding the budget-holder perspective, one study calculated the budget impact from the hospital perspective (66), five adopted the health-plan perspective (45,46,48,55,64), and 16 adopted the third-party payer perspective including public health insurance, Medicare, and commercial insurance (42-44, 47-54, 56, 58, 59, 61, 65, 68). Five studies reported results from more than one perspective (43,50,54,58,68).…”

“…Of those, in five studies (14%), the authors took subsequent treatment costs based on guideline recommendations into account, while in the other six studies (24%), the authors took the subsequent treatment costs based on their own model structure and relative considerations into account. For example, Kongnakorn et al(50) calculated the costs of post-progression (on subsequent 3 line active treatment) and post-progression/off-treatment (best supportive care) as subsequent treatment costs, while Stellato et al (52) developed a Markov model and considered the costs of subsequent recurrence events in patients. Bly et al(54) andMistry et al (…”