Vemurafenib Does Not Impact Health Plan Budget

Caroline Helwick

July 2012, Vol 3, No 5 - AMCP Annual Meeting

San Francisco, CA—Although the upfront cost of vemurafenib is high, its use to treat patients with metastatic melanoma actually results in a costsavings per health plan member per month (PMPM), according to an analysis presented at the 2012 Academy of Managed Care Pharmacy annual meeting.

In a hypothetical health plan of 500,000 enrollees, the use of vemurafenib for the treatment of patients with BRAF V600E mutation is costsaving by $0.04 PMPM, reported William B. Wong, MS, PharmD, of the University of Washington, Seattle.

“Overall, our findings imply that providing vemurafenib therapy will have relatively minimal budget impact and may possibly be cost-saving,” Dr Wong said.

The BRAF inhibitor vemurafenib is designed to inhibit the V600E-mutated form of the BRAF protein, which plays an important role in progression of this disease. The drug was approved last year for patients with BRAF V600E mutation–positive unresectable or metastatic melanoma. For this study, researchers developed a budget impact model as a tool that can be used by healthcare plans to assess the budgetary impact of covering vemurafenib for treatment-naïve and previously treated patients.

The researchers considered 2 hypothetical scenarios when (1) vemurafenib is not a treatment option for melanoma with BRAF V600E mutation and (2) vemurafenib is a treatment option in treatment-naïve and previously treated patients, and is used until disease progression or unacceptable toxicity for a proportion of eligible patients.

The model was based on a health plan with 500,000 enrollees; the estimated annual costs were based on several variables of treating this eligible patient population.

Patients who tested positive for the mutation received vemurafenib first line and other agents as second and third line on progression. If they tested negative, they never received vemurafenib but did receive alternative treatments. Patients who were not tested received alternative agents but were tested for the mutation after second- line treatments failed. If appropriate, the patients received vemurafenib at that time.

Cost data sources included the Analysource drug database and 2011 Centers for Medicare & Medicaid Services national payment rates.

Cost Impact

The analysis found that 6.6 cases of metastatic melanoma (stage IIIC unresectable and stage IV) were expected in a 500,000-member plan annually, including 4.9 new cases and 1.7 recurrent cases. The total costs and PMPM costs were $1,215,838 for patients in scenar io 1 who did not receive vemurafenib and $978,129 for those in scenario 2 who were treated with the drug.

The results were relatively sensitive to the proportion of patients receiving ipilimumab (also recently approved for the first-line treatment of metastatic melanoma), the cost of ipilimumab, the proportion of patients receiving vemurafenib, the percentage of patients positive for the V600E mutation, and the percentage of patients receiving first-line treatment.

Dr Wong acknowledged that the model only includes therapies that are approved by the US Food and Drug Administration and are recommended by the National Comprehensive Cancer Network guidelines, but he said that “the effect of excluding some therapies is likely to be minor, since the proportion of patients receiving these treatments is small.”

Unresectable stage IIIC patients and patients with recurrence after ≥5 years were not included, because of the small population sizes. The model did not consider efficacy beyond its immediate impact on expenditures, and the distribution of patients estimated to receive these treatment options is based on market research data obtained by surveys of physicians.