San Diego—In the first study to estimate the budgetary impact of accepting pemetrexed as maintenance therapy for non–small-cell lung cancer (NSCLC), researchers found that adopting the drug did not significantly affect a health plan’s budget.
Using a model designed to represent a 1 million–member health plan over a 1 year time frame, the research team—consisting of members from the consulting firm Medical Decision Modeling and Eli Lilly—input a series of variables, including:
The model showed that, assuming a 50% increase in the number of patients receiving maintenance therapy as a result of the adoption of pemetrexed, the total annual cost increase would be $365 323. However, considering savings from patients who would switch to maintenance therapy from more expensive first-line therapy, the net budget impact would be $317 070. This translated to a cost of $679.22 per treated member per month and a per member per month cost (PMPM) of $0.026.
The team concluded that only large increases in the number of maintenance patients would likely cause PMPM costs to rise by more than 3 cents. According to lead study author Robert Klein, the findings provide “valuable information to consider in evaluating treatment options available to plan members.” Outcomes researcher Bruce Hillner, a professor and associate chair of Information Sciences in the Department of Internal Medicine at Virginia Commonwealth University who was not affiliated with the study, notes that anchoring future research in data from health plan audits will improve the understanding of pemetrexed’s impact on health plan budgets.
