Budget impact of netupitant/palonosetron for the prevention of chemotherapy-induced nausea and vomiting.

Abstract

Background: Chemotherapy-induced nausea and vomiting (CINV) are among the most common and debilitating side-effects patients experience during chemotherapy, and are associated with considerable acute care use and healthcare cost. It is estimated that 70-80% of CINV could be prevented through appropriate use of CINV prophylaxis; however, suboptimal CINV compliance and control remains an issue in clinical practice. Netupitant/palonosetron (NEPA) is a fixed combination of serotonin-3 (5-HT3) and neurokinin-1 (NK1) receptor antagonists (RAs), respectively, indicated for the prevention of acute and delayed nausea and vomiting associated with highly emetogenic chemotherapy (HEC) and moderately emetogenic chemotherapy (MEC). Phase 3 clinical trials showed a significantly higher complete response rate in both acute and delayed CINV in chemotherapy-naïve patients receiving NEPA compared to patients receiving palonosetron. Objective: The objective of this study was to estimate the budgetary impact of adding NEPA to a US payer or practice formulary for CINV prophylaxis. Methods: A model was developed to estimate the impact of adding NEPA to the formulary of a hypothetical US payer with 1.15 million members, including 150,000 (13%) Medicare beneficiaries. The model compared the annual total costs of CINV-related events and CINV prophylaxis in two scenarios: base year (no NEPA) and comparator year (10% and 5% NEPA usage in HEC and MEC patients, respectively). A univariate sensitivity analysis was conducted to explore the effect of variability in model parameters on the budget impact. Results: A total of 2,021 patients were eligible to receive CINV prophylaxis. With NEPA, CINV prophylaxis costs increased by 0.7% ($3,493,630 vs $3,518,760) while medical costs associated with CINV events decreased by 3.9% ($15,118,639 vs $14,532,442), resulting in a net cost saving of $561,067 (3.0%) for the health plan ($18,612,269 vs $18,051,202), or $0.04 per member per month. This was equivalent to saving $5,011 per patient moved to NEPA. Among all 5-HT3 RA + NK1 RA regimens, NEPA was associated with the lowest CINV-related costs, leading to the lowest total cost of care. Conclusions: Adding NEPA to a payer or practice formulary results in a net decrease in the total budget due to a substantial reduction in CINV event-related resource utilization and medical costs, and an increase in pharmacy costs <1%, saving over $5,000 per patient.

• Authors: Sang Hee Park, Gary Binder, Shelby Corman, Marc Botteman
• Journal: Journal of medical economics (J Med Econ) Vol. 22 Issue 8 Pg. 840-847 (Aug 2019) ISSN: 1941-837X [Electronic] England
• PMID: 31094589 (Publication Type: Journal Article)

Chemical References

• Antiemetics
• Antineoplastic Agents
• Drug Combinations
• Pyridines
• Palonosetron
• netupitant

Topics

• Aged
• Aged, 80 and over
• Antiemetics (economics, therapeutic use)
• Antineoplastic Agents (adverse effects)
• Budgets (statistics & numerical data)
• Drug Combinations
• Female
• Humans
• Male
• Medicare (statistics & numerical data)
• Nausea (chemically induced, prevention & control)
• Palonosetron (economics, therapeutic use)
• Pyridines (economics, therapeutic use)
• United States
• Vomiting (chemically induced, prevention & control)