PSY46 - A DYNAMIC APPROACH FOR BUDGET IMPACT ANALYSIS (BIA) IN ONCOLOGY – THE CASE OF NOVEL TREATMENT COMBINATIONS FOR FRONTLINE TRANSPLANT-INELIGIBLE NEWLY DIAGNOSED MULTIPLE MYELOMA (TIE NDMM)

Abstract

A BIA static approach is often used by budget-holders to evaluate the financial impact of new treatments. However, this approach often under-values oncologic innovative products that significantly delay disease progression to a later and costlier disease state. Using TIE ndMM as an illustrative example, we propose a dynamic BIA model that follows patients and associated costs as they progress to later states of MM. A 5-year horizon model was developed using a French payer perspective. Patient cohorts enter the model each year and are tracked within the following health states: pre-progression, post-progression and death. Published literature was used to estimate overall survival and progression-free survival (PFS) rates for the current standard of care (SoC) for TIE ndMM (bortezomib-melphalan-prednisone [VMP] or lenalidomide-dexamethasone [Rd]). Drug and disease management costs were also derived from published literature. Assuming 33% uptake for the novel combination, the dynamic approach was compared with the traditional approach using 3 scenarios with hazard ratios (HR) for PFS of 0.5, 0.75, and 1.0. Compared with the traditional approach, the dynamic approach estimated lower budget impacts for all PFS HR scenarios, with greater reductions linked to improvements in the HR to Rd for PFS. Namely, with an HR of 0.5, 0.75, and 1, the budget impacts were significantly reduced by 50%, 47%, and 45%, respectively, after Year 1, and by 73%, 59%, and 52%, respectively, by the end of Year 5. The dynamic approach more accurately estimates the budgetary impact of novel multiple myeloma combinations and demonstrates the value these innovations brings to patients and health-care systems in terms of prolonging the progression-free state versus SoC.