title: Budget impact of erlotinib for maintenance therapy in advanced non-small cell lung cancer.
abstract: OBJECTIVE
  Assess the budgetary impact of adding erlotinib for maintenance therapy (MTx) in advanced non-small cell lung cancer (NSCLC) from a US health plan perspective.
  
  
  METHODS
  A budget impact model was developed to analyze the costs (drug, administration, adverse events) associated with adding erlotinib MTx to a hypothetical 500,000 member US health plan. Treatment durations and dosing were derived from randomized controlled trials, FDA labeling, and National Comprehensive Cancer Network guidelines. Treatment patterns and assumptions were based on market research data, the SEER registry, and published literature. Cost data were obtained from Centers for Medicare and Medicaid Services payment rates and a drug pricing database. Sensitivity analyses were conducted to assess uncertainty.
  
  
  RESULTS
  Overall health plan expenditures increased by $0.010 per member per month (PMPM). The main driver of additional cost was the erlotinib drug cost (∼$66,000) with the administration ($464) and side-effect ($47) costs being relatively modest. One-way sensitivity analyses showed that the results were most sensitive to the proportion of members receiving MTx; however, the PMPM did not exceed $0.013.
  
  
  CONCLUSIONS
  The overall budget impact to a health plan of expanding the use of erlotinib from the 2nd/3rd-line advanced NSCLC setting to include the maintenance setting was relatively small. This was primarily due to the proportion of patients who would receive erlotinib MTx, the low cost of side-effects and minimal cost of drug administration. Additional research may be warranted to estimate the relative clinical and economic impacts of erlotinib MTx versus alternative MTx treatments.
authors.affiliation: University of Washington, Pharmaceutical Outcomes Research and Policy Program, Seattle, WA, USA. Carlsojj@u.washington.edu
authors.forename: Josh J
authors.initials: JJ
authors.lastname: Carlson
authors.forename: William B
authors.initials: WB
authors.lastname: Wong
authors.forename: David L
authors.initials: DL
authors.lastname: Veenstra
authors.forename: Carolina
authors.initials: C
authors.lastname: Reyes
mesh_terms: D000328:Adult; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000191:economics / Q000627:therapeutic use; D002017:Budgets / Q000706:statistics & numerical data*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000191:economics*; D014487:Centers for Medicare and Medicaid Services, U.S.; D000077143:Docetaxel; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics; D000069347:Erlotinib Hydrochloride; D005260:Female; D005971:Glutamates / Q000191:economics / Q000627:therapeutic use; D006147:Guanine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000191:economics*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D000068437:Pemetrexed; D047428:Protein Kinase Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D011799:Quinazolines / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D012042:Registries / Q000706:statistics & numerical data; D043823:Taxoids / Q000191:economics / Q000627:therapeutic use; D014481:United States
chemical_list: D000964:Antimetabolites, Antineoplastic; D005971:Glutamates; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D043823:Taxoids; D000068437:Pemetrexed; D000077143:Docetaxel; D006147:Guanine; D000069347:Erlotinib Hydrochloride