PCN59 - Budget Impact of the Introduction of Subcutaneous Rituximab to U.S. Health Plans

Abstract

A recent FDA-approved formulation of rituximab offers a subcutaneous (SC) route of administration. The SC product has labeled indications for the treatment of follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and chronic lymphocytic leukemia (CLL). We sought to estimate the financial impact of converting rituximab eligible patients from the intravenous (IV) route of administration to SC from the perspective of a commercial health insurance plan. We created a de novo budget impact model using Microsoft® Excel in order to evaluate the costs of drug, administration, and adverse events. We applied costs across several uptake scenarios of patients receiving SC and IV rituximab within a hypothetical one-million-member health plan. We forecasted budget impact at 1, 2 and 3 years. Wholesale drug acquisition costs were used for the two drugs, while infusion and SC injection costs were estimated from the Marketscan® databases. Grade 3 and 4 adverse events occurring >5% of treated patients also were included. We estimated treatment costs and annual per-member-per-month (PMPM) in each year. To assess parameter uncertainty, we developed one-way and multi-way sensitivity analyses. Using reported incidence rates for the labeled indications, we estimate that 150 newly diagnosed patients in the hypothetical health plan would be eligible for rituximab - FL (n=56), DLBCL (n=63), or CLL (n=31). We show that rituximab treated patient costs are reduced year over year, in proportion to the change in converted market share from the IV to SC formulation. In the year with the highest conversion rate, total costs were approximately $223,000 lower translating to a PMPM decrease of $0.02. Lower CLL rituximab costs and lower administration costs were the main drivers of these cost reductions. Switching patients with FL, DLBCL and CLL from IV to SC rituximab can reduce pharmacy and overall PMPM costs for commercial health plans.