Per Member Per Month Research Articles

Budget Impact of 12-Month Fixed Treatment Duration Venetoclax in Combination with Obinutuzumab in Previously Untreated Chronic Lymphocytic Leukemia Patients in the United States.

This study aimed to assess the total cost of care (TCC) and budget impact of introducing 12-month fixed duration venetoclax + obinutuzumab (VEN+G) as first-line treatment for chronic lymphocytic leukemia (CLL) from the perspective of a US health plan with 1,000,000 (1M) members. The 3-year model included the following comparators: fludarabine + cyclophosphamide + rituximab (FCR), bendamustine + rituximab (BR), obinutuzumab + chlorambucil (GClb), ibrutinib (Ibr), and Ibr+Rituximab/obinutuzumab [Ibr+R/Ibr+G]). TCC included US-specific costs associated with treatment (i.e., drug, administration, and wastage), adverse events, routine care, and monitoring. Dosing and safety data were drawn from clinical trials and US package inserts. Budget impact outcomes were presented on an absolute and per-member per-month (PMPM) basis. Sensitivity analyses explored uncertainty in influential parameters, including scenarios testing the duration of treat-to-progression agents. Over the 3-year time horizon, introducing VEN+G in a 1M-member health plan resulted in total cost savings of $1,550,663 (PMPM -$0.04), compared to a scenario without VEN+G. The fixed 12-month duration of VEN+G contributed to this cost saving by reducing cumulative treatment costs compared with Ibr-based regimens. By year 3, the cumulative difference in TCC of VEN+G compared with Ibr, Ibr+G, and Ibr+R amounted to -$300,942, -$367,001, and -$369,784, respectively. Extensive sensitivity analyses supported the base case findings. Introducing VEN+G among first-line CLL treatments to a US health plan resulted in cost savings compared to a plan with chemoimmunotherapies and Ibr-based therapies only. Economic benefits of VEN+G, a novel agent with fixed treatment duration, coupled with proven clinical benefits should help inform formulary adoption decisions and treatment recommendations.

PCN164 THE BUDGET IMPACT OF TTFIELDS + PLATINUM-BASED THERAPY FOR FIRST-LINE MESOTHELIOMA TREATMENT

A budget impact model was created to estimate the financial impact to a payer when introducing TTFields in combination with pemetrexed and a platinum agent to the formulary for malignant pleural mesothelioma (MPM). The budget impact model compared a pre-approval scenario to a post-approval scenario over a five-year time horizon for a theoretical plan containing two million lives in the United States. The model assumed a first-line treatment rate of 70% for MPM. Available first-line treatments included pemetrexed + cisplatin, pemetrexed + cisplatin/carboplatin + bevacizumab, pemetrexed monotherapy, gemcitabine + platin, gemcitabine monotherapy, and vinorelbine monotherapy. The market share of TTfields + pemetrexed + cisplatin/carboplatin was assumed to rise linearly from 9% in year one to 22.5% in year five. The market share gain for TTFields was proportionally subtracted from all other available first-line therapeutic regimens. The model considered overall survival and adverse events based on clinical trial data. Dosing assumptions were based on clinical trial data, NCCN guidelines, and package inserts. Subsequent therapy was considered for 30% of eligible patients. Costs included drug/device, administration, adverse event, and subsequent therapy. All costs are presented in 2019 USD and sourced from Medicare and Novocure. Costs were discounted at 3%. The forecasted budget impact of introducing TTFields + pemetrexed + cisplatin/carboplatin was $374,104 (per member per month (PMPM) = $0.003) over the five-year time horizon. The increase in budget was driven by higher drug and device costs of $370,593 (PMPM = $0.003) and subsequent therapy costs of $55,224 (PMPM = $0.0005). Drug administration and adverse event costs were reduced by $4,641 (PMPM = $0.00004) and $47,073 (PMPM = $0.0004), respectively. The introduction of TTFields to the formulary of a theoretical two million patient health plan resulted in a small overall and PMPM increase in the budget.

PMH47 INTEGRATED PHARMACY BENEFITS ARE ASSOCIATED WITH REDUCED TOTAL MEDICAL SPENDING FOR MEMBERS WITH MENTAL HEALTH CONDITIONS: A BCBSLA PERSPECTIVE

While pharmacy benefit carve-outs are promoted as a cost-containment tool, their impact on total medical spending is not well understood. We compare the healthcare spending of Blue Cross Blue Shield of Louisiana members with mental health conditions covered by an integrated (“carved-in”) pharmacy benefit with members covered under a pharmacy benefit carve-out. The study population included all Blue Cross members with continuous medical coverage from October 1, 2014 to September 30, 2018 with a diagnosis of one of the following mental health diseases: Depression, Anxiety Disorders, or Other Mental Health Diagnosis. Participants were primary members whereby their companies contracted Administrative Services Only (ASO) through Blue Cross. Additional inclusion were that members had to be continuously enrolled for four consecutive years in either a Carve-In or Carve-Out program. Outcomes of interest include: per member per month (PMPM) annual expenditures, emergency room visits and inpatient hospitalizations. Carve-Out mental health patients were 1:1 exact matched to Carve-In patients based on member demographics (gender, region), chronic comorbidities (Asthma, Diabetes), program participation (CMDM, Quality Blue, Product Network) and annual risk severity category (Healthy, Stable, At Risk, Struggling, In Crisis). After exact matching our final sample was 20,485 members. Of which, 3,944 (19%) members were identified to have a mental health condition. These members accounted for about one-third of the total cost in the first year of the study (32% vs 33%). Findings show average annual costs consistently increase year over year for the Carve-Out patients (difference >$33.12 PMPM) with mental health conditions versus those in the Carve-In program. Members with mental health conditions receiving an integrated pharmacy benefit experienced slower medical cost growth compared to members covered by a pharmacy carve-out. Managers may want to consider the implications of pharmacy benefit design for total cost of care, not just prescription drug costs.

PCN58 A US BUDGET IMPACT MODEL FOR SELINEXOR IN COMBINATION WITH DEXAMETHASONE FOR THE TREATMENT OF PATIENTS WITH RELAPSED OR REFRACTORY MULTIPLE MYELOMA (RRMM)

To estimate the projected budgetary impact of adopting selinexor use in the intended patient population from the perspective of a third-party payer (private payer or Medicare) in the US. A budget impact analysis was conducted in one-year increments for the first 3 years after the introduction of selinexor as a treatment for eligible patients with penta-refractory MM. The number of eligible patients was derived from the incidence of MM reported in US epidemiology statistics from multiple sources. Total annual treatment costs were calculated as the sum of drug costs, best supportive care costs, and costs of treating serious adverse events (grade 3 or higher). Dosing, duration of treatment, and rates of adverse events were obtained from the prescribing information for selinexor. In a hypothetical private payer plan with one million members, annual number of selinexor eligible patients was estimated to be 4. In the base-case analysis, the introduction of selinexor was associated with a limited budget impact with a per member per month (PMPM) cost of $0.0103 in year 3, assuming a market uptake of 64%. The budget impact remained modest in a scenario analysis in which the selinexor eligible population included patients with triple-class refractory MM regardless of the number of prior lines of therapy with an estimated PMPM cost of $0.0388. The model showed comparable sensitivity to treatment duration, wholesale acquisition cost for selinexor, and year 1 uptake, when base-case inputs were varied by ±10%. Model results for a hypothetical medicare plan was also associated with a limited budget impact. With limited treatment options in the later lines, newly developed drug Selinexor in combination with dexamethasone for the treatment of multiple myeloma will have a small BI for a US health plan.

Evaluating the Impact of Freespira on Panic Disorder Patients' Health Outcomes and Healthcare Costs within the Allegheny Health Network.

Panic disorder (PD) is a debilitating condition that drives medical spending at least twice as high as medically matched controls. Excessive utilization of healthcare resources comes from emergency department (ED), medications, diagnostic testing, and physician visits. Freespira is an FDA-cleared digital therapeutic that treats PD and panic attacks (PA) by correcting underlying abnormal respiratory physiology. Efficacy of Freespira has been established in prior studies. This paper reports on a quality improvement program that investigated whether treating PD patients with Freespira would reduce medical costs and improve outcomes over 12-months. Panic symptoms were assessed using the Panic Disorder Severity Scale (PDSS). Pre-and post-treatment insurance claims determined costs. At baseline, mean Clinician Global Impression (CGI-S) was 4.4 (moderately/markedly ill), mean PDSS was 14.4 and mean PA frequency/week was 2 (range 0-5). Immediately post-treatment (week 5) mean CGI-S, PDSS and weekly PA frequency declined to 2.8 (borderline/mildly ill, 4.9 (remission) and 0.2 (range 0-2) respectively, p < 0.001. 82% reported PDSS decrease of ≥ 40% (clinically significant), 86% were PA-free. One-year post treatment mean CGI-S, PDSS and PA remained low at 2.1, 4.4, and 0.3 (range 0-1) respectively. 91% had PDSS decrease of ≥ 40%, 73% were PA-free. The majority of patients were panic attack free and/or reduced their symptoms and avoidance behaviors 1-year post Freespira treatment. Mean overall medical costs were reduced by 35% from $548 to $358 PMPM (per member per month) or an annual reduction of $2280. at 12months post-treatment. There was a 65% reduction in ED costs from $87 to $30 PMPM. Median pharmacy costs were reduced by 68% from $73 to $23 PMPM.

The Budget Impact of Introducing Tildrakizumab to a United States Health Plan for Managing Moderate-to-Severe Plaque Psoriasis.

ObjectiveThe aim of this study was to evaluate the budget impact of introducing tildrakizumab for moderate-to-severe plaque psoriasis from a US health plan perspective.MethodsA budget impact model estimated costs before and after the adoption of tildrakizumab to a hypothetical US health plan with 1 million covered lives over 5 years. Additionally, the model included adalimumab, brodalumab, etanercept, guselkumab, ixekizumab, secukinumab, ustekinumab, and apremilast; biosimilars were not included. Model input data were obtained from the published literature, clinical trials, and prescription data. Market uptake for tildrakizumab was assumed as 1% annually over 5 years. Patients initiating or switching treatments required induction dosing; all others treated required maintenance dosing. The model compared the total annual costs for tildrakizumab versus treatment without tildrakizumab to calculate budget impact in 2018 US dollars. Scenarios exploring alternative assumptions for adverse events and market uptake rates were assessed, and a one-way sensitivity analysis was conducted.ResultsWithin a health plan of 1 million members with an estimated 1048 patients receiving biologics or apremilast for psoriasis, the total annual health plan cost after introducing tildrakizumab decreased by $5585, $137,025, $205,538, $274,051, and $342,563 in years 1–5, respectively, resulting in a cumulative reduction of $964,763 over 5 years. The impact on total cost was largely due to drug acquisition costs. The incremental per member per month (PMPM) cost reductions were negligible in year 1, $0.01 in year 2, $0.02 in years 3–4, and $0.03 in year 5. Scenario and sensitivity analyses confirmed the model robustness.ConclusionsThe introduction of tildrakizumab with a 1% annual uptake over 5 years has the potential to reduce the cost of treating patients with moderate-to-severe plaque psoriasis for a US health plan.Electronic supplementary materialThe online version of this article (10.1007/s41669-020-00208-9) contains supplementary material, which is available to authorized users.

Health Care Expenditures Among Adults With Diabetes After Oregon's Medicaid Expansion.

To compare trends in Medicaid expenditures among adults with diabetes who were newly eligible due to the Affordable Care Act (ACA) Medicaid expansion to trends among those previously eligible. Using Oregon Medicaid administrative data from 1 January 2014 to 30 September 2016, a retrospective cohort study was conducted with propensity score-matched Medicaid eligibility groups (newly and previously eligible). Outcome measures included total per-member per-month (PMPM) Medicaid expenditures and PMPM expenditures in the following 12 categories: inpatient visits, emergency department visits, primary care physician visits, specialist visits, prescription drugs, transportation services, tests, imaging and echography, procedures, durable medical equipment, evaluation and management, and other or unknown services. Total PMPM Medicaid expenditures for newly eligible enrollees with diabetes were initially considerably lower compared with PMPM expenditures for matched previously eligible enrollees during the first postexpansion quarter (mean values $561 vs. $793 PMPM, P = 0.018). Within the first three postexpansion quarters, PMPM expenditures of the newly eligible increased to a similar but slightly lower level. Afterward, PMPM expenditures of both groups continued to increase steadily. Most of the overall PMPM expenditure increase among the newly eligible was due to rapidly increasing prescription drug expenditures. Newly eligible Medicaid enrollees with diabetes had slightly lower PMPM expenditures than previously eligible Medicaid enrollees. The increase in PMPM prescription drug expenditures suggests greater access to treatment over time.

Evaluation of four disease management programs: evidence from blue cross blue shield of Louisiana

Aims: Chronic diseases impose a substantial healthcare burden. This study sought to evaluate the clinical and economic impact of new disease management (DM) programs, targeting four major chronic disease groups: diabetes, coronary heart disease (CHD)/hypertension (HTN), asthma/chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF)/chronic kidney disease (CKD).Materials and methods: Between March 1, 2015, and February 28, 2018, members with Blue Cross Blue Shield of Louisiana insurance were contacted and enrolled in a DM program if they were aged 18 years through 64 years, eligible for a DM program, and had not been previously enrolled in a DM program. Active enrollees of a DM program (“IN” group) were compared to members who were not yet enrolled (“OUT” group). Average per member per month (PMPM) costs were aggregated annually to document any descriptive trends. Multivariable model estimates were used to compare PMPM costs for all IN subjects and all OUT subjects. Total medical savings were evaluated for the following time intervals: 1–12 months, 13–24 months, and 25–36 months.Results: For all four DM programs, average costs PMPM trended upward over time for the OUT cohort, while they remained relatively stable for the IN cohort. Some evidence also showed that DM programs improved clinical outcomes, such as hemoglobin A1c values. A difference in difference analysis showed PMPM savings for all four programs combined of $31.61, $50.45, and $53.72 after 1, 2, and 3 years, respectively. Multivariable modeling results showed total savings after 3 years of $14,460,174 for all DM programs combined.Limitations: Although multivariable models adjusted for several clinical, demographic, and economic characteristics; it is possible that some important confounders were missing due to lack of data.Conclusions: DM programs implemented to control diabetes, CHD/HTN, CHF/CKD, and asthma/COPD are cost-effective and show some evidence of improved clinical outcomes.

Medical utilization surrounding initial opioid-related diagnoses by coding method.

To identify methods for coding initial opioid-related disorder (ORD) diagnoses in administrative claims and determine whether coding methods correspond to acute medical utilization patterns. Retrospective analysis of Blue Health Intelligence commercial data. We included members with 2 years of continuous coverage around the first appearance of an ORD diagnosis code (initial ORD) in medical or pharmacy claims with dates of service between October 2015 and March 2016. Initial ORD was identified by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) F11 codes or buprenorphine for medication-assisted treatment (BUP-MAT) with a duration of 3 or more days. Descriptive analyses were evaluated prediagnosis, in the month of diagnosis, and post diagnosis and included mean cost per member per month (PMPM); mean monthly percentage of members with at least 1 opioid agonist prescription (OAP), inpatient visit, or emergency department (ED) visit; and percentage of members with at least 1 ICD-10-CM Z79.891 code (long-term [current] use of opiate analgesic). A total of 6426 initial ORD diagnoses were identified by F11.20 (65.2%), F11.x (28.7%), and BUP-MAT (6.1%). PMPM costs for BUP-MAT ($2054) were lower than for F11.20 ($5053) and F11.x ($6597) in the diagnosis month. Mean monthly percentage of members with at least 1 OAP declined from pre- to post initial ORD diagnosis (F11.20, 52.5% to 50.0%; F11.x, 44.1% to 37.9%; BUP-MAT, 34.0% to 12.7%). Members with initial ORD coded as F11.x had the highest mean percentage with at least 1 inpatient or ED visit in the diagnosis month (30.9% and 26.8%, respectively) versus F11.20 (19.3% and 10.8%) and BUP-MAT (5.1% and 3.5%). Percentage of members with at least 1 Z79.891 code was higher post diagnosis than in the month of diagnosis (F11.20, 34.6% vs 25.7%; F11.x, 16.5% vs 8.1%; BUP-MAT, 19.5% vs 8.1%). Medical utilization patterns of members with ORD differ by the coding method used to document their initial diagnosis in administrative claims.

Effect of a Virtual Pharmacy Review Program: A Population Health Case Study.

The growing emphasis on value-based health care has created a need for innovative population health management strategies. Pharmacists are underused resources for implementation of meaningful population health models that ensure appropriate medication use through optimization of electronic medical record (EMR) technology and pharmacist knowledge. The objective of our program was to improve the health outcomes of a patient population with diabetes while also reducing costs. A virtual pharmacy review (ViPRx) program was used to remotely provide previsit comprehensive medication reviews for patients in the defined population. The pharmacist used the EMR to review medications and relevant histories and to intervene when needed to ensure appropriate medication use. Pharmacist recommendations and supporting statements were delivered to the provider's EMR in-box 1-2 days before a scheduled visit. The information technology resources and virtual model allow the pharmacist to manage patient care and collaborate with providers electronically across multiple clinic locations. The pharmacist managed a panel of over 700 patients in this virtual model. The program has yielded improvements in key diabetes metrics. Most notable is a 6% increase in the percentage of patients with a hemoglobin A1c (HbA1c) value of 9% or less and a 7% improvement in the controlled low-density lipoprotein (LDL) measure. Monitoring parameters (nephropathy screening, HbA1c, and LDL) increased by 8%-12% from baseline. Additional positive outcomes include improved medication adherence in the defined population as seen by a 1.5% improvement in medication possession ratio for diabetes medications. Reductions in per member per month (PMPM) prescription costs are estimated at $11 per month through discontinuation of unnecessary and duplicate medications. The results of this case study on the effect of a virtual pharmacy review program demonstrate an opportunity for pharmacists to engage in a population health management model that improves patient outcomes and may reduce the rate at which PMPM prescription drug costs increase. No outside funding supported this work. The authors have no conflicts of interest to disclose. This work was presented at the 2017 Vizient Connections Summit; April 6, 2017; Las Vegas, NV, and the 2018 Cerner Health Conference; October 10, 2018; Kansas City, MO.

Economic Burden of Multiple Myeloma: Results from a Large Employer-Sponsored Real-World Administrative Claims Database, 2012 to 2018

Introduction: Multiple myeloma (MM) is a relatively rare, but serious neoplasm of terminally differentiated B-lymphocytes. Patients with MM experience clinical remission as well as relapses and refractory responses to therapy. New drugs and new combination therapies for MM in the past decade have increased the overall survival rate from 4.6 years to 6.1 years [Kumar et al., Leukemia 2014]. In recent years, there has been increasing emphasis towards determining the value of novel therapies based on the clinical and economic data. For example, ASCO, NCCN and ICER have developed value frameworks to evaluate cancer treatments. Since 2015 several therapies have received FDA approval for treatment of patients with MM although there is limited economic data for these newer MM treatments. Thus, the objective of the current study was to assess all-cause and disease-related health care utilization and costs among newly diagnosed and treated patients with MM in the U.S. Study Design, Materials and Methods: This retrospective, observational study design was conducted using a large national administrative claims database (IBM® MarketScan® Commercial and Medicare Supplemental Databases). Data includes persons enrolled in commercial health plans or in Medicare supplemental plans. Study participants were identified using medical and pharmacy claims from about 163 million individuals enrolled in a plan at any time from 1-1-2011 to 6-30-2018. Patients with MM were identified based on the following criteria: (1) At least two MM diagnoses (using ICD-9-CM 203.00-203.02; or ICD10: C90.00-C90.02 codes) between 1-1-2012 and 6-30-2017 with the first observed diagnosis date set as the MM diagnosis index date (MMDID); (2) ≥12 months of continuous enrollment prior to, and ≥2 months post, MMDID; (3) Patients received MM drug therapy after diagnosis; (4) Age ≥18 years at MMDID; and (5) Patients with any other malignant cancer prior to, or at, the time of MMDID were excluded; All patients were followed from MMDID until end of data set (6-30-2018) or to end of health plan enrollment, whichever was first (i.e., the follow-up period.). All-cause- and MM-related (claims with MM diagnosis or treatment) health care utilization and costs were assessed during the follow-up period. All analyses were descriptive in nature. Results: There were 3,144 newly diagnosed MM patients eligible for this study with mean (std dev) age of 65.4 (11.7) years.56% were males and 42.8% had ≥1 comorbidity during the follow-up period (mean follow-up: 21.5 months). Following first-line treatment, 56.1% received 2L therapy, 29.9% received 3L, 15.7% received 4L, and 7.6% had ≥5 lines of treatment (Figure 1). In the first line, monotherapy was used for 24%, doublets were used for 38%, triplets for 37%, and 4 or more drugs for 1.5% of patients. Some drug regimens had up to 9 drugs. Among the selected cohort, 94.8% had ≥1 MM-related hospital outpatient visit, and 81.7% had ≥1 outpatient pharmacy claim. Furthermore, 77.7% of patients had ≥1 MM-related inpatient hospital admission with an average (std dev) length of stay for each admission of 12 (11.06) days. Total average (std dev) follow-up costs from all causes (AC) were $288,304 ($333,673) of which MM-Disease Related (DR) costs for all lines of therapy accounted for $253,071 (87.8%). Pharmacy drugs accounted for 32.9% of total DR costs, while hospital inpatient visits were 29.3% of cost and hospital outpatient (mostly provider-administered drugs) were 26.2% of total DR costs (Figure 2). A breakdown of total DR costs by line of therapy is reported in Figure 3. The DR cost per member per month (PMPM) for the total follow-up period was $14,140. The mean (std dev) DR PMPM costs for each line of therapy were $16,342 ($20,028) for 1L, $19,267 ($29,645) for 2L, $17,773 ($23,347) for 3L, and $20,146 ($26,401) for 4L. Conclusion: This study documents recent trends in economic and resource use burden in patients with MM including trends following the approval of newer treatments (2015). Pharmacy and hospital inpatient utilization accounted for two-third of total DR-costs. In combination with the clinical data, the economic and resource use data serve as inputs in assessing value and budget impact of newer treatment Disclosures Tran: AbbVie: Other: Internship. Kamalakar:AbbVie: Employment, Other: and may hold stock or stock options. Manthena:AbbVie: Employment, Other: may own stocks/options. Karve:AbbVie: Employment, Other: stock/stock options.

Budget Impact of Glasdegib in Combination with Low-Dose Cytarabine for the Treatment of First-Line Acute Myeloid Leukemia in the United States

I ntroduction Acute myeloid leukemia (AML) is an orphan disease and has one of the lowest five-year survival rates among myeloid malignancies in United States (US) adults (28.3% on average, 5% of which are aged 65 years or older). Older patients with AML have few treatment options and are often not candidates for intensive induction chemotherapy, therefore novel therapeutic strategies are needed. A phase II randomized study (Cortes et al. 2019) among newly diagnosed AML patients who were not candidates for intensive induction chemotherapy demonstrated improved overall survival (OS) in patients treated with glasdegib in combination with low-dose cytarabine (LDAC) compared to patients receiving LDAC alone. The present analysis estimated the budget impact of including glasdegib combined with LDAC as first-line treatment for these AML patients from a US health plan perspective. Methods The budget impact was assessed using a decision analytic model that compared the current market environment where glasdegib + LDAC was not included with a new market environment where glasdegib + LDAC was included. The comparators in the model were LDAC alone, azacitidine, decitabine, and venetoclax combined with LDAC, azacitidine or decitabine. The budget impact was calculated based on epidemiology inputs, market share inputs, clinical inputs and all relevant cost inputs (i.e. drug and administration cost, medical resource use cost, adverse event cost). The base case was calculated for a US commercial health plan of 1 million members with a time horizon of 3 years. The main outcomes were total costs of current and new market environments, incremental budget impact, incremental cost per member per month (PMPM) and incremental cost per treated patient per month (PTPPM). Both deterministic sensitivity analyses and scenario analyses were performed to assess the uncertainty of the structure and inputs of the model. Results The analysis estimated an eligible patient population of 19 AML patients per year (per million members) who are not candidates for intensive induction chemotherapy. Of these: 2, 4 and 6 patients were estimated to receive glasdegib + LDAC in years 1, 2 and 3, respectively. In the base case, the incremental budget impact of glasdegib + LDAC was $179,290 in year 1, $262,694 in year 2 and $346,098 in year 3. This translated into an incremental cost PMPM of $0.0149, $0.0219, and $0.0288 in years 1, 2, and 3, respectively. The model results were most sensitive to the mean OS of glasdegib + LDAC. Conclusions The introduction of glasdegib + LDAC as a treatment for newly diagnosed AML patients who are not candidates for intensive induction chemotherapy has a small impact on the budget of US payers, given the small size of the eligible patient population. The model results suggest glasdegib + LDAC provides an alternative treatment option while extending life at minimal incremental cost for health plans. As such, glasdegib + LDAC may provide substantial value for money spent on treatment of these AML patients in the US for which treatment options are few. Disclosures Pham: Pfizer: Consultancy, Other: funding from Pfizer. Milev:Evidera: Consultancy, Other: funding from Pfizer. Li:Evidera: Consultancy, Other: funding from Pfizer. Zou:Evidera: Consultancy, Other: funding from Pfizer. Hu:Ingress-health: Consultancy, Employment, Other: funding from Pfizer. Heeg:Ingress-Health: Employment. Bell:Pfizer Inc.: Employment, Equity Ownership.

Employer-mandated obstructive sleep apnea treatment and healthcare cost savings among truckers.

To evaluate the effect of an employer-mandated obstructive sleep apnea (OSA) diagnosis and treatment program on non-OSA-program trucker medical insurance claim costs. Retrospective cohort analysis; cohorts constructed by matching (randomly, with replacement) Screen-positive Controls (drivers with insurance screened as likely to have OSA, but not yet diagnosed) with Diagnosed drivers (n = 1,516; cases = 1,224, OSA Negatives = 292), on two factors affecting exposure to medical claims: experience level at hire and weeks of job tenure at the Diagnosed driver's polysomnogram (PSG) date (the "matching date"). All cases received auto-adjusting positive airway pressure (APAP) treatment and were grouped by objective treatment adherence data: any "Positive Adherence" (n = 932) versus "No Adherence" (n = 292). Bootstrap resampling produced a difference-in-differences estimate of aggregate non-OSA-program medical insurance claim cost savings for 100 Diagnosed drivers as compared to 100 Screen-positive Controls before and after the PSG/matching date, over an 18-month period. A two-part multivariate statistical model was used to set exposures and demographics/anthropometrics equal across sub-groups, and to generate a difference-in-differences comparison across periods that identified the effect of OSA treatment on per-member per-month (PMPM) costs of an individual driver, separately from cost differences associated with adherence choice. Eighteen-month non-OSA-program medical claim costs savings from diagnosing (and treating as required) 100 Screen-positive Controls: $153,042 (95% CI: -$5,352, $330,525). Model-estimated effect of treatment on those adhering to APAP: -$441 PMPM (95% CI: -$861, -$21). Results suggest a carrier-based mandatory OSA program generates substantial savings in non-OSA-program medical insurance claim costs.

Economic evaluation of passive monitoring technology for seniors

BackgroundAdvances such as passive monitoring technology (PMT), which provides holistic supervision of chronically ill and elderly patients, enable and support improved monitoring and observation, thus empowering the growing population of older adults to live more independently while lowering health care expenses.AimsThis study develops a conceptual model to estimate the potential savings associated with PMT.MethodsWe first develop a conceptual model to identify the main cost variables associated with independent living, focusing on three pathways: (1) PMT, (2) independent living supported by the current standard of care, and (3) facility-based care. We examined the impact on three outcomes [i.e., health care costs, institutional costs, and health-related quality of life (HRQoL)] along each of the three care pathways (i.e., PMT, independent living supported by the standard of care, and facility-based care) and developed a cost-benefit model to calculate the net costs and benefits associated with each care pathway.ResultsThe cost–benefit model showed savings between approximately $425 per-member per-month (PMPM) for those using PMT compared to those on the standard of care pathway. Sensitivity analysis demonstrated that a 5% increase in nursing home utilization generates cost savings of more than 30% PMPM.DiscussionThe total projected cost savings for individuals on the PMT arm are projected to be more than $425 PMPM, with annual savings of $5069 per-person per-year, and over $5.1 million for a target population of 1000 individuals.ConclusionsThe cost calculations in our cost–benefit simulation model clearly demonstrate the value of PMT and show the potential value to payers and integrated delivery systems in offering PMT to individuals who are likely to benefit the most from the services.

Comparison of surgical payer costs and implication on the healthcare expenses between laparoscopic magnetic sphincter augmentation (MSA) and laparoscopic Nissen fundoplication (LNF) in a large healthcare system

IntroductionMagnetic sphincter augmentation (MSA) is a promising antireflux surgical treatment. The cost associated with the device may be perceived as a drawback by payers, which may limit the adoption of this technique. There are limited data regarding the cost of MSA in the management of reflux disease. The aims of the study were to report the clinical outcome and quality of life measures in patients after MSA and to compare the pharmaceutical and procedure payer costs and the disease-related and overall expense of MSA compared to laparoscopic Nissen fundoplication (LNF) from a payer perspective.Methods and proceduresThis prospective observational study was performed in conjunction with the region’s largest health insurance company. Data were collected on patients who underwent MSA over a 2-year period beginning in September 2015 at the study network hospitals. The LNF comparison group was procured from members’ claims data of the payer. Inclusion was predicated by patients having continuous coverage during study period. The total procedural reimbursement and the disease-related and overall medical claims submitted up to 12 months prior to surgery and up to 12 months following surgery were obtained. The payer reimbursement data are presented as allowed cost per member per month (PMPM). These values were then compared between groups.ResultsThere were 195 patients who underwent MSA and 1131 that had LNF. MSA results in comparable symptom control, PPI elimination rate, and quality of life measures compared to values reported for LNF in the literature. The median (IQR) reimbursement of surgery was $13,522 (13,195–14,439) for those who underwent MSA and $13,388 (9951–16,261) for patients with LNF, p = 0.02. In patients who underwent MSA, the median reimbursement related to the upper gastrointestinal disease was $ 305 PMPM, at 12 months prior to surgery and $ 104 at 12 months after surgery, representing 66% decrease in cost. These values were $ 233 PMPM and $126 PMPM for patients who underwent LNF, representing a 46% decrease (p = 0.0001). At 12 months following surgery, the reimbursement for overall medical expenses had decreased by 10.7% in the MSA group and 1.4% in the LNF group when compared to the preoperative baseline reimbursement. The reimbursement for PPI use after surgery showed a 95% decrease in the MSA group and 90% among LNF group when compared to the preoperative baseline (p = 0.10).ConclusionWhen compared with LNF, MSA results in a reduction of disease-related expenses for the payer in the year following surgery. While MSA is associated with a higher procedural payer cost compared to LNF, payer costs may offset due to reduction in the expenses after surgery.

Multifaceted Care Model for CHF Improves Health System and Patient Economic Outcome

Introduction Inconsistent piece-meal care for a chronic multidimensional disease like CHF results in poor clinical outcomes, therefore a chronic disease Care model that provides multifaceted holistic chronic disease management in the post-acute setting, aligning a multidisciplinary dedicated heart care team to a narrow network of home/community service providers implementing evidence based protocols across the continuum; namely a Care pathway improves outcomes. Specifically, this pathway may include daily inpatient CHF identification and navigation as follows: Heart protocol implementation & training at exclusively partnered Skilled Nursing/LTAC/Home Health after concerted CHF Education (at those facilities) of Nurse practitioners (32 hours) RN Aides (3 hours) and RN (6 hours) of evidence based curriculum.Participating in daily phone huddle along with daily telehealth from the partnered facilities and home health with daily reporting/monitoring of progress eg., vitals, diet, PT/OT progress, etc.Incorporating care of chronic comorbidities including Diabetes and COPD and working concomitantly with those Care pathways.Discharge planning under the supervision of central CRNP and multi-disciplinary team including physician follow-up The above model and it's pathways revealed improvement in clinical outcomes, particularly 30 day readmissions that were reported at the HFSA 2018 but the economic impact of such interventions are unknown. Hypothesis The above mentioned comprehensive approach to HF and it's proven improved clinical outcomes may also translate into economic savings. Methods A total of 1982 Allegheny Health/Highmark (AHN) patients are on the above mentioned Care pathway, out of which 337 were identified (from May 2017 until Dec 2018) as possible matches to patients outside of the system (deemed as “Market”) with similar attributes such as clinical severity, comorbidities and index facility ie., tertiary vs. community hospitals. The above match was blinded and performed by an independent non clinical entity to maintain investigational integrity. Results After placement on the pathway, patient cost defined as per member per month (PMPM) was less expensive than market by $357 primarily driven by 30% decrease in post discharge inpatient cost and 12% decrease in post-acute costs (see Fig 1). Conclusion Economic benefit can be achieved in tandem with better clinical outcome via multifaceted CHF care.

Cost and Utilization Outcomes After Exclusion of Dipeptidyl Peptidase-4 Inhibitors and Other Diabetes Drug Category Changes in a Self-Funded, State Employee Managed Care Plan.

Dipeptidyl peptidase-4 (DPP-4) inhibitors have repeatedly shown no reduction in the clinical outcomes of cardiovascular death, myocardial infarction, stroke, or all-cause mortality. Because the treatment of diabetes is generally one of the top drug categories by cost to health plans and self-funded employers, it is necessary to evaluate coverage of DPP-4 inhibitors, considering their lack of cardiovascular benefit relative to other treatment options. To describe the cost and utilization outcomes of drugs used to treat diabetes after exclusion of DPP-4 inhibitors in a self-funded managed care plan. This study was a retrospective, descriptive analysis of the cost and utilization outcomes after exclusion of DPP-4 inhibitors. Pharmacy claims data and plan membership were analyzed 6 months before DPP-4 inhibitor exclusion (preperiod: December 1, 2016-May 31, 2017) and 6 months after DPP-4 inhibitor coverage ended for all users (postperiod: September 1, 2017-February 28, 2018). The allowed amount, which is not influenced by overlapping plan copay changes, and utilization per member per month (PMPM) were used to estimate the effect of the DPP-4 inhibitor benefit exclusion on plan costs for the antidiabetic class. From preperiod to postperiod, all DPP-4 inhibitor products decreased in utilization by 3.02 claims per 1,000 members per month (PTMPM). Glucagon-like peptide-1 receptor agonists, insulins, sodium-glucose cotransporter-2 inhibitors, and thiazolidinedione claims increased by 0.72, 0.43, 0.30, and 0.48 claims PTMPM, respectively, but there was an absolute decrease of 1.35 claims for antidiabetic medications per 1,000 plan members. However, the days supplied PMPM increased from 2.55 to 2.61 (2.3%) days. Allowed amount PMPM increased by $0.27 from $12.19 in the preperiod to $12.31 in the postperiod (2.2%). However, it is estimated that drug cost inflation accounted for over half of the PMPM increase in allowed costs. The observed increase in the allowed amount PMPM was attributable in similar amounts by an increase in utilization of medications with higher cost per day supplied and higher drug prices. Future research will evaluate patient-level effects of this benefit change in terms of antidiabetic medication utilization and outcomes. No outside funding supported this study. Davis, Bemberg, and Johnson currently work for or previously worked for the UAMS Evidence-Based Prescription Drug Program, which advises the Employee Benefits Division (EBD) on pharmacy benefit management. The EBD did not provide any additional funding for this study. McAdam-Marx reports grants from AstraZeneca and Sanofi Aventis outside the submitted work. The other authors have no other relevant information to disclose.

An economic evaluation of tofacitinib for the treatment of moderately-to-severely active ulcerative colitis: modeling the cost of treatment strategies in the United States

Aims: To evaluate the cost differences between a treatment strategy including tofacitinib (TOFA) vs treatment strategies including adalimumab (ADA), golimumab (GOL), infliximab (IFX), and vedolizumab (VEDO) among all patients with moderate-to-severe ulcerative colitis (UC) (further stratified by patients naïve/exposed to tumor necrosis factor inhibitors [TNFis]).Materials and methods: An Excel-based decision-analytic model was developed to evaluate costs from the perspective of a third-party US payer over 2 years. Efficacy and safety parameters were taken from prescribing information and published trials. All patients started induction therapy on the first treatment in the strategy and continued if efficacy criteria were met and no major adverse event occurred (in which cases they proceeded to the next treatment in the strategy).Results: The cost per member per month (PMPM) of the TOFA–>IFX–>VEDO–>GOL strategy ($1.11) was lower than that of the ADA–>IFX–>VEDO–>GOL strategy ($1.34; Δ = $−0.23) among the TNFi-naïve population (n = 204 patients out of a plan of one million members). Similarly, the use of TOFA before ADA (i.e. TOFA–>ADA–>IFX–> VEDO) was also associated with lower PMPM costs than the use of ADA before TOFA (i.e. ADA–>TOFA–>IFX–>VEDO): $1.15 vs $1.25 (Δ = $−0.10). Similar, and often larger, differences were observed in both the overall moderate-to-severe population and the TNFi-exposed population. Sensitivity analyses resulted in the same conclusions.Limitations: Our model relied on efficacy data from prescribing information and published trials, which were not head-to-head and slightly differed with respect to methods. Additionally, our model used representative minor and major ADRs (and the associated costs) to represent toxicity management, which was a simplifying assumption.Conclusions: This analysis, the first of its kind to evaluate TOFA vis-à-vis other advanced therapies in the US, suggests the early use of TOFA among both TNFi-naïve and TNFi-failure patients results in lower PMPM costs compared with other treatment alternatives.

PCN107 BUDGET IMPACT ANALYSIS OF LAROTRECTINIB FOR 8 TUMORS IN THE UNITED STATES

Larotrectinib is an oral tropomyosin receptor kinase (TRK) inhibitor indicated for cancers where the tumor expresses neurotrophic tyrosine receptor kinase (NTRK) gene fusions. We assessed potential budget impact of the introduction of larotrectinib. In accordance with the expected pan-tumor indication, we assessed the financial implications of covering larotrectinib across 8 tumors: colorectal, non-small cell lung, melanoma, thyroid, gastrointestinal stromal tumor, infantile fibrosarcoma, soft tissue sarcoma, and salivary gland cancer. We created a budget impact model with a flexible time horizon. The model framework centralizes parameter control while separately modeling the available treatments, dosing, and market share for each of the 8 tumor types. The base case assumed a commercial U.S. health plan of 1,000,000 enrollees. The treated population for each tumor type was estimated from SEER, TRK fusion testing rate assumptions, fusion mutation prevalence, and treatment uptake assumptions. The budget impact was calculated as total and per member per month (PMPM) cost. Scenario analyses were performed in order to approximate the uncertainty in the base case results and identify likely financial determinants. We estimated that less than one patient would be treated with larotrectinib across the eight tumor types in the first year after accounting for the frequency of NTRK gene fusion in each tumor type. The total costs in year 1 without larotrectinib were $41,300 compared to $68,000 with the first year of larotrectinib uptake, an increase of $26,700 (less than $0.001 PMPM). Over three years, we estimated 1 patient was treated with larotrectinib, a PMPM increase of $0.01. The increase in costs was due proportionally to increased costs of genetic testing and increased drug costs. These results were most sensitive to the parameters that define the treated population. Adding larotrectinib is likely to have minimal additional costs when added to a health plan formulary.

PCN98 A BUDGET IMPACT (BI) ANALYSIS OF PEMETREXED IN COMBINATION WITH PEMBROLIZUMAB AND PLATINUM CHEMOTHERAPY FOR INITIAL TREATMENT OF PATIENTS WITH METASTATIC NON-SQUAMOUS (NSQ) NON-SMALL CELL LUNG CANCER (NSCLC) IN THE U.S.

Given significantly improved survival shown in KEYNOTE-189 and KEYNOTE-21G trials with addition of pembrolizumab to pemetrexed and platinum chemotherapy (Pem+Pembro+Plat) compared to pemetrexed and platinum as initial treatment for patients with metastatic NSQ NSCLC, a BI analysis is warranted to estimate the impact on a payer’s budget from reimbursing Pem+Pembro+Plat. The BI analysis evaluated costs to a US commercial payer from addition of Pem+Pembro+Plat to a mix of existing treatment regimens. Applying published epidemiology data to a hypothetical one-million-member health plan, 206 patients per year with metastatic NSQ NSCLC, without EGFR or ALK aberrations, and eligible for initial therapy were estimated. Market share estimates were used to calculate number of patients receiving each regimen annually, with 40.5% of patients receiving Pem+Pembro+Plat when available. Acquisition, administration, and ancillary treatment-related costs were calculated for each regimen based on the average duration of treatment with each drug in the regimen from published data. Costs for grade 3+ adverse events were calculated from published studies. The BI analysis results were reported annually. One-way sensitivity analyses were performed on acquisition and adverse event costs. Total cost without Pem+Pembro+Plat was $17,604,901 vs. $25,168,238 with Pem+Pembro+Plat, for a net increase of $7,563,337. Cost per member per month (PMPM) without Pem+Pembro+Plat was $1.467 vs. $2.097 with Pem+Pembro+Plat, for a net PMPM cost of $0.630. Cost per treated member per month (PTMPM) without Pem+Pembro+Plat was $7,105 vs. $10,158 with Pem+Pembro+Plat, for a net PTMPM cost of $3,052. One-way sensitivity analysis showed that changes in acquisition costs of pembrolizumab, bevacizumab, and pemetrexed had most impact on incremental total and per-member costs. The increase in a US commercial payer’s annual budget from introduction of Pem+Pembro+Plat as a treatment option may be justifiable in light of improvement in survival with Pem+Pembro+Plat over traditional chemotherapy.