PCN40 - Budget Impact of Albumin-Bound Paclitaxel + Gemcitabine in the Treatment of Metastatic Pancreatic Cancer

Abstract

In a Phase III clinical trial (Von Hoff, NEJM 2013) albumin-bound paclitaxel (nab-P) plus gemcitabine (nab-P/G) significantly improved median overall survival (OS) in first-line metastatic pancreatic cancer (1LmPanc) patients vs. gemcitabine (G) alone (8.7 vs. 6.6 months, hazard ratio 0.72, P<0.001). The objective of this analysis is to estimate the budget impact of adding nab-P/G for 1LmPanc treatment at a US health plan. A budget impact model was built to estimate 1LmPanc costs for nab-P/G, G, Erlotinib + Gemcitabine (EG), Other G combinations (OG), and FOLFIRINOX (F), from a US health plan perspective in 2013 US dollars. Inputs for drug, administration, G-CSF, and adverse events were derived from prescribing information, publications, Medicare reimbursement rates, and other public sources. Sensitivity analysis assessed utilization mixes and elderly populations. A 1,000,000-member health plan mirroring the US population age mix would have 70 patients with 1LmPanc annually. The model assumed equal proportions of G, EG, OG, and F (25% of patients each) at baseline, and equal use (20% each) after nab-P/G 1LmPanc approval. Total course of therapy costs were G $2,634, EG $22,555, OG $10,840, F $39,437. Baseline total mPanc costs were $1.3 million, or $0.11 per member per month (PMPM). Adding nab-P/G at $29,096 per course of therapy added $142,610, or $0.01 PMPM, to the baseline. In a sensitivity analysis with 50% of patients using nab-P/G, incremental cost was $0.03 PMPM. For a health plan population age 65-79, baseline cost of $0.48 PMPM rose $0.05 PMPM from nab-P/G. If only 70% of 1LmPanc patients received drug therapy, costs from nab-P/G rose $0.01 from $0.08 PMPM at baseline. The budget impact of adding albumin-bound paclitaxel plus gemcitabine for a US health plan’s first-line metastatic pancreatic cancer patients was estimated at $0.01 PMPM; the impact was consistent across several sensitivity analyses.