Document Detail

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.
MedLine Citation:
PMID:  23153318     Owner:  NLM     Status:  MEDLINE    
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.
LIMITATIONS: 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.
Jipan Xie; Melissa Diener; Gourab De; Hongbo Yang; Eric Q Wu; Madhav Namjoshi
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-12-05
Journal Detail:
Title:  Journal of medical economics     Volume:  16     ISSN:  1941-837X     ISO Abbreviation:  J Med Econ     Publication Date:  2013  
Date Detail:
Created Date:  2013-01-15     Completed Date:  2013-06-18     Revised Date:  2014-10-02    
Medline Journal Info:
Nlm Unique ID:  9892255     Medline TA:  J Med Econ     Country:  England    
Other Details:
Languages:  eng     Pagination:  278-88     Citation Subset:  IM    
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MeSH Terms
Antineoplastic Agents / economics*,  therapeutic use
Breast Neoplasms / chemistry,  drug therapy*,  epidemiology
Cost-Benefit Analysis
Drug Costs / trends*
Health Care Costs
Middle Aged
Nitriles / therapeutic use
Receptor, Epidermal Growth Factor*
Receptor, erbB-2*
Severity of Illness Index
Sirolimus / analogs & derivatives*,  economics,  therapeutic use
Treatment Failure
Triazoles / therapeutic use
United States / epidemiology
Reg. No./Substance:
0/Antineoplastic Agents; 0/Nitriles; 0/Triazoles; 112809-51-5/letrozole; 120511-73-1/anastrozole; 159351-69-6/everolimus; EC, Epidermal Growth Factor; EC, erbB-2; W36ZG6FT64/Sirolimus
Comment In:
J Med Econ. 2014 Sep;17(9):617   [PMID:  24826964 ]
J Med Econ. 2014 Apr;17(4):248-9   [PMID:  24506762 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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