PCN52 BUDGET IMPACT OF SUBA-ITRACONAZOLE CAPSULES (SUBA-ITRA) FOR THE TREATMENT OF SYSTEMIC MYCOSES IN THE U.S.

Abstract

The objective of this analysis was to estimate the incremental budget impact (BI) of adopting SUBA-ITRA, a new oral formulation of itraconazole, in adult systemic mycoses (SM) patients. An incidence-based model was developed from a U.S. payer perspective covering a three-year horizon, using a hypothetical cohort of 1-million healthcare plan members. In the base-case, SM included histoplasmosis and blastomycosis but excluded aspergillosis. Primary treatments included SUBA-ITRA, conventional itraconazole, voriconazole, and posaconazole. Health states were modeled to capture treatment efficacy in terms of Diagnosis, Oral treatment phase, Stabilization, Cure, Relapse, Discontinuation, and Mortality. Costs for oral drug treatment, healthcare resource utilization, adverse events, indirect (productivity) and mortality were included. Drug costs were based on Medispan wholesale acquisition costs. The estimated cost of conventional itraconazole assumed 10% brand/90% generic use with the proportion of generic substitution tested in sensitivity analysis. Healthcare resource and indirect costs were obtained from the Healthcare Cost and Utilization Project and US Bureau of Labor Statistics for 2018, respectively. Of a hypothetical cohort of 1-million plan members, 32 incident SM patients were estimated per year. Projected market share uptake of SUBA-ITRA was 5%, 10%, and 15%, yielding 2, 3, and 5 patients in years 1-3. Over the modeled three years, adoption of SUBA-ITRA resulted in a decreased total health plan cost of $22,379 versus the status quo (relative BI of -0.10% and per-member per-month savings of $0.0006). Cost savings from SUBA-ITRA adoption was based on lower rates of relapse and associated retreatment, mortality, and less productivity loss. Estimated savings were partially offset by higher SUBA-ITRA oral treatment costs during primary and maintenance therapy. Based on the present model, the introduction of SUBA-ITRA reduced the cost of SM treatment by $22,379 over three years for a hypothetical health plan of 1-million U.S. members.