Economic Impact of Erlotinib Maintenance Therapy in the Treatment of Non–Small-Cell Lung Cancer

June 2011, Vol 2, No 3 -

Minneapolis, MN—Erlotinib is a human epidermal growth factor receptor inhibitor administered as maintenance therapy in the treatment of locally advanced or metastatic non–small-cell lung cancer (NSCLC) that has not progressed after 4 cycles of platinum-based first-line therapy.

Data from the Sequential Tarceva in Unresectable NSCLC (SATURN) study, first reported in 2009, suggest that erlotinib (Tarceva) can improve overall survival and progression-free survival in some patients undergoing chemo therapy for advanced NSCLC.

Using a budgetary assessment model based on a hypothetical health plan population of 500,000 enrollees, a team of investigators from the University of Washington, Seattle, and Genentech, San Francisco, analyzed the economic impact of adding erlotinib maintenance therapy to a multistep chemotherapy regimen for advanced NSCLC. The results were presented in a poster session at the 2011 Academy of Managed Care Pharmacy annual meeting.

Josh J. Carlson, MPH, PhD, and colleagues analyzed data from the SATURN study, the Surveillance, Epidemiology and End Results (SEER) Medi care study, and US census and market research data to estimate the expected annual cost of therapy for eligible patients with NSCLC, according to the following criteria: the 1-year incidence of patients with stage IIIb/IV NSCLC that is appropriate to receive maintenance therapy; the proportion of eligible patients expected to receive first-, second-, or third-line and maintenance therapy; the per-patient cost of medi cation and drug administration; and treatment of drug-related adverse events.

Among this hypothetical plan population, 133 members would be undergoing treatment for advanced NSCLC, of which 11 would be receiving first-line treatment for squamous, or bevacizumab (Avastin)-ineligible nonsquamous, disease that does not progress after 4 cycles of platinum-based chemotherapy. Among the 11 members eligible for erlotinib, 4 would receive maintenance therapy.

The total health plan costs with erlotinib as a treatment option totaled to $318,066, with a change in total cost of $62,279, or $0.0104 per member per month.

Dr Carlson explained the increase as “primarily driven by the addition of erlotinib maintenance therapy and the subsequent increased use of secondand third-line agents that have higher costs than erlotinib.”

He added that the model did not address recurrent NSCLC or efficacy beyond its immediate impact on expenditures, nor did it consider other maintenance therapy options in the base-case analysis. Nevertheless, he concluded, “adding maintenance therapy with erlotinib to a health plan formulary has a small budgetary impact.”

The budget impact of erlotinib in patients with NSCLC “is a tool that can be used by healthcare plans to assess the budgetary impact of covering erlotinib as a maintenance therapy,” Dr Carlson and his colleagues observed.