Aims
To estimate the budget impact of adding capmatinib, the first FDA approved MET inhibitor, to a US commercial or Medicare health plan for patients with metastatic non-small cell lung cancer (mNSCLC) whose tumors have a mutation that leads to MET exon 14 (METex14) skipping.
Methods
Target population size was estimated using published epidemiology data. Clinical data were obtained from the GEOMETRY mono-1 capmatinib trial and published trials. Treatments in the market mix included crizotinib, pembrolizumab, ramucirumab, and chemotherapy. Uptake of capmatinib and testing rates were based on market research. All costs (drug acquisition and administration, pre-progression, progression, terminal care, adverse event, and testing) were estimated based on public sources (2020 USD).
Results
The number of patients eligible for capmatinib in the first three years was estimated to be 2-3 in a hypothetical 1 million member commercial plan and 34-44 in a hypothetical 1 million member Medicare plan each year. The estimated total budget impact ranged from $9,695 to $67,725 for a commercial plan and $141,350 to $985,695 for Medicare. With capmatinib included, a marginal per member per month budget impact was estimated (commercial: $0.0008 to $0.0056; Medicare: $0.0118 to $0.0821). Capmatinib inclusion resulted in lower medical costs (commercial: -$0.0003 to -$0.0007; Medicare: -$0.0037 to -$0.0106), partially offsetting increased drug costs ($0.0011 to $0.0064; $0.0154 to $0.0928, respectively), and were primarily driven by reductions in progression and terminal care costs (-$0.0003 to -$0.0009; -$0.0037 to -$0.0125, respectively). The results were most sensitive to capmatinib market share, capmatinib price, and treatment duration.
Limitations
Certain assumptions were applied to the model to account for inputs with limited evidence.
Conclusions
The estimated budget impact of including capmatinib for mNSCLC with a METex14 skipping mutation is minimal, and the increased drug costs were partially offset by savings in AEs, and progression-related and terminal care costs.
Associated People
Weiguang Xue
Mr. Xue consults on cases involving health economics and outcomes research (HEOR). He specializes in using health economics analyses to inform product launch strategies, as well as decision making in early-stage clinical development. Mr. Xue has extensive experience in the economic evaluation of health technologies across multiple therapeutic areas, including oncology, infectious diseases, autoimmune diseases, central nervous system diseases, ophthalmology, and gynecology. His work includes cost-effectiveness analysis, budget impact analysis, systematic literature review, indirect treatment comparison, evaluation of health care resource use, global value dossier, and market access strategy. He has led successful health technology assessment (HTA) submissions to the National Institute for Health and Care Excellence (NICE), the Scottish Medicines Consortium (SMC), and the All Wales Medicines Strategy Group (AWMSG). He has also developed global economic models across multiple indications and led country rollouts supporting market access in Europe, North America, and Asia.