title: Budget impact analysis of everolimus for the treatment of hormone receptor positive, human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer in the United States.
abstract: OBJECTIVE
  To estimate the budget impact of everolimus as the first and second treatment option after letrozole or anastrozole (L/A) failure for post-menopausal women with hormone receptor positive (HR+), human epidermal growth factor receptor-2 negative (HER2-) advanced breast cancer (ABC).
  
  
  METHODS
  Pharmacy and medical budget impacts (2011 USD) were estimated over the first year of everolimus use in HR+, HER2- ABC from a US payer perspective. Epidemiology data were used to estimate target population size. Pre-everolimus entry treatment options included exemestane, fulvestrant, and tamoxifen. Pre- and post-everolimus entry market shares were estimated based on market research and assumptions. Drug costs were based on wholesale acquisition cost. Patients were assumed to be on treatment until progression or death. Annual medical costs were calculated as the average of pre- and post-progression medical costs weighted by the time in each period, adjusted for survival. One-way and two-way sensitivity analyses were conducted to assess the model robustness.
  
  
  RESULTS
  In a hypothetical 1,000,000 member plan, 72 and 159 patients were expected to be candidates for everolimus treatment as first and second treatment option, respectively, after L/A failure. The total budget impact for the first year post-everolimus entry was $0.044 per member per month [PMPM] (pharmacy budget: $0.058 PMPM; medical budget: -$0.014 PMPM), assuming 10% of the target population would receive everolimus. The total budget impacts for the first and second treatment options after L/A failure were $0.014 PMPM (pharmacy budget: $0.018; medical budget: -$0.004) and $0.030 PMPM (pharmacy budget: $0.040; medical budget: -$0.010), respectively. Results remained robust in sensitivity analyses.
  
  
  CONCLUSIONS
  Assumptions about some model input parameters were necessary and may impact results.
  
  
  CONCLUSIONS
  Increased pharmacy costs for HR+, HER2- ABC following everolimus entry are expected to be partially offset by reduced medical service costs. Pharmacy and total budget increases were modest.
authors.affiliation: Analysis Group, Inc., 10 Rockefeller Plaza, New York, NY 10020, USA. jxie@analysisgroup.com
authors.forename: Jipan
authors.initials: J
authors.lastname: Xie
authors.forename: Melissa
authors.initials: M
authors.lastname: Diener
authors.forename: Gourab
authors.initials: G
authors.lastname: De
authors.forename: Hongbo
authors.initials: H
authors.lastname: Yang
authors.forename: Eric Q
authors.initials: EQ
authors.lastname: Wu
authors.forename: Madhav
authors.initials: M
authors.lastname: Namjoshi
mesh_terms: D000077384:Anastrozole; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy* / Q000453:epidemiology; D002017:Budgets; D003362:Cost-Benefit Analysis; D016527:Drug Costs / Q000639:trends*; D066246:ErbB Receptors; D000068338:Everolimus; D005260:Female; D017048:Health Care Costs; D006801:Humans; D000077289:Letrozole; D008875:Middle Aged; D009570:Nitriles / Q000627:therapeutic use; D018719:Erb-b2 Receptor Tyrosine Kinases; D012720:Severity of Illness Index; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D017211:Treatment Failure; D014230:Triazoles / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
chemical_list: D000077384:Anastrozole; D000970:Antineoplastic Agents; D066246:ErbB Receptors; D000068338:Everolimus; D000077289:Letrozole; D009570:Nitriles; D018719:Erb-b2 Receptor Tyrosine Kinases; D020123:Sirolimus; D014230:Triazoles