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

Abstract

Coverage for targeted first-line erlotinib therapy in NSCLC likely results in a small budget impact for US health plans. The estimated impact may vary by plan, or if second-line or maintenance therapy, dose changes/interruptions, or impact on patients' quality-of-life were included.

A Methodological Review of US Budget-Impact Models for New Drugs

“…Five of the ten studies compared the current or old treatment mix with a new treatment mix including the new drug [47,50,51,53,54]. In all five of these studies, the drug for which the budget impact was estimated took treatment share from all drugs.…”

“…Of the eight models that used the static cost-calculator approach, four used a prevalent population with the condition for which the new drug was indicated and assumed no change in population size during the model time horizon [50][51][52][53]. The other four models used an incident population capturing only those newly indicated for treatment with the new drug [47][48][49]54]. The size of the incident population would not be expected to change for any of the diseases being modeled, but the treated population size would be expected to increase over time with new drugs that decrease mortality or slow disease progression, allowing for a longer time on treatment.…”

“…For ten of the models of chronic illness, the clinical data indicated that a decrease in mortality or disease progression rates during the model time horizon would be expected with use of the new drug [47][48][49][50][51][52][53][54][55][56]. Eight of these models used a simple cost-calculator model structure [47][48][49][50][51][52][53][54], and only two used a decision-analytic model structure [55,56].…”

“…Although these studies all focused on chronic conditions, seven of the eight cost-calculator models assumed a time horizon of 1 year [47][48][49][51][52][53][54], either assuming that the mortality rates were sufficiently high that no patients would be alive in subsequent years for those with advanced cancer or that the budget impact would be the same in subsequent periods for those with congestive heart failure. In the other cost-calculator model [50] and the two decision-analytic models [55,56], time horizons varied from 3 to 10 years.…”

“…Eight of these models used a simple cost-calculator model structure [47][48][49][50][51][52][53][54], and only two used a decision-analytic model structure [55,56]. Seven of the eight cost-calculator models were for advanced or metastatic cancers [47-51, 53, 54], and one was for congestive heart failure [52].…”