A Comparison of Second-line Multiple Myeloma Treatment Cost in UK and US

1,801 views

Published on

This ebook from IHS compares the actual cost (minus administration costs) of bortezomib monotherapy treatment versus lenalidomide / dexamethasone therapy in second-line Multiple Myeloma in the United States and United Kingdom.

Published in: Health & Medicine, Business
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,801
On SlideShare
0
From Embeds
0
Number of Embeds
12
Actions
Shares
0
Downloads
26
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

A Comparison of Second-line Multiple Myeloma Treatment Cost in UK and US

  1. 1. A Cross-country Cost Comparisonof Second-Line Multiple Myeloma Treatments D E V E LO P E D B Y: Sophia Walker Gustav Ando Milena Izmirlieva Praful Mehta
  2. 2. Contents Purpose .......................................................................... 3 Methodology .................................................................. 4 Assumptions................................................................... 5 Results ........................................................................... 6 Conclusions .................................................................... 8 Meet the Analysts ......................................................... 102 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.
  3. 3. Purpose The standard of care for second-line multiple myeloma This study seeks to compare the actual cost (minus (MM) treatment includes both bortezomib monotherapy administration costs) of bortezomib monotherapy treatment treatment, an injectable, and lenalidomide/dexamethasone, versus lenalidomide/dexamethasone therapy in second-line both capsules. However, the difference in treatment cost MM in the United States and United Kingdom. of each therapy has not been well established.3 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.
  4. 4. Methodology The IHS OncoInsight Market Access Database was Cost Calculations reviewed to find the ex-manufacturing package price and To derive the cost curve across pooled treatment regimes, price per mg of each drug. All prices were from H1 2010. the cost calculations were performed for 95% confidence interval ranges of all the recorded TTP values in the clinical Dosing and Treatment Duration trials. For more details on the various TTP values used to Dosing schedules were followed as stipulated in the clinical project the cost curve, please refer to the clinical trial protocol trial documents. According to the clinical information for bortezomib and lenalidomide/dexamethasone. provided in the label, lenalidomide/ dexamethasone was to be stopped at treatment progression, therefore the duration Cost calculations were based on total dosage in mg of use was derived from time-to-progression (TTP) figures. multiplied by cost per mg. For bortezomib monotherapy, the duration of use was extracted from the label, which specified that the mean number of doses during the APEX study was 22. In order to identify the treatment landscape fully, dose ranges were derived from the respective labels. For each treatment, based on the range of TTP in months, the total number of treatment cycles and thus total dosage in mg were identified.4 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.
  5. 5. Assumptions ƒ Number of days in a month: 30.416 ƒ Average body surface area: 1.75 m2 (365 days/12 months). ƒ Price based on pack size of 3.5-mg vial for bortezomib, ƒ Average dosage ranges for bortezomib monotherapy and a pack size of 25 tablets of 25 mg each in the US based on the assumption that patients were taken and 25 tablets of 21 mg each in the UK for lenalidomide. off treatment at progression, although not stipulated in the label. ƒ Exchange rate based on IHS Global Insight’s proprietary exchange-rate figures for 2010: GBP1.00:USD1.54 ƒ Calculation based on the assumption that patients Additionally, HTA decisions on the drugs were identified. received the unmodified dose of the drug, excluding any dosing changes in response to clinical and laboratory findings undertaken in the clinical study described in the label.5 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.
  6. 6. Results Harmonised Cost Comparison Using the highest number of doses documented in the Based on the median TTP, the total average treatment APEX study (44), the totals come to USD34,091.06 and cost for the lenalidomide/dexamethasone treatment was GBP19,416.4 (USD29,901.26). In order to harmonise the com- USD101,052.75 in the US and GBP58,926.78 (USD 90,747.24) parison, we also calculated total dosage at median TTP in the UK. Based on an average total dosage of 22, the total values of 6.2 months for bortezomib. The resulting values average treatment costs of bortezomib monotherapy were were USD27,892.68 and GBP15,886.14 (USD24,464.66). At a USD17,045.53 in the US and GBP9,708.2 (USD14,950.63) constant exchange-rate basis, both treatments were relatively in the UK. more expensive in the US than the UK. Dosing Curves for lenalidomide+ dexamethasone in Multiple Myeloma Dosing Curves for bortezomib in Multiple Myeloma 35000 120 30000 15046.0 100.1 100 81.90 84.18 86.45 25000 11623.1 80 20000 10283.7 65.98 8349.0 60 56.88 15000 10550.6 10000 6900.6 7927.2 40 5417.9 5000 4495.4 20 2931.2 3383.0 3695.9 8.8 4.2 4.9 6.2 6.3 6.9 0 9.5 12.1 13.9 18.5 0 1 2 3 4 1 2 3 4 5 6 TTP Values in Months Total dexamethasone (mg) Total lenalidomide (mg) Total len + dex (mg) TTP Values in Months Total Mg of bortezomib (mg) Dosing Curves for lenalidomide/dexamethasone in Multiple Myeloma Dosing Curves for bortezomib in Multiple Myeloma6 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.
  7. 7. Results (continued) Cost Curves for lenalidomide+ dexamethasone and bortezomib in Multiple Myeloma in the UK and US $350,000 $300,000 $134,344 $250,000 $101,054 $200,000 $88,028 $69,212 $120,743 $150,000 $90,745 $100,000 $79,006 $62,051 $50,000 $27,892.68 $28,667 $29,442 $34,091 $17,046 $19,370 $22,469 $25,824 $29,901 $14,951 $16,989 $19,708 $24,464.66 $25,144 $0 Series 1 Series 2 Series 3 Series 4 Series 5 Series 6 Series 7 Total Cost of bortezomib - UK ($) Total Cost of bortezomib - US ($) Total Cost of len + dex - UK ($) Total Cost of len + dex - US ($) Cost Curves for lenalidomide/dexamethason and bortezomib in Multiple Myeloma in the UK and US7 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.
  8. 8. Conclusion The research suggests that in both the US and UK, NICE guidance officially and unofficially affects treatment (minus administration) costs with bortezomib pharmacoeconomic analysis in other countries, particularly is significantly lower than lenalidomide/ dexamethasone. in the EU, meaning that NICE’s decisions on post first-line Additionally, both treatments were found to be less MM treatments could have significant implications for expensive in the UK. These findings are aligned with NICE’s other markets deciding whether and how to reimburse decision to position bortezomib ahead of lenalidomide/ these treatments. dexamethasone in the treatment sequence. However, the fact that both treatments relied on a PAS to receive Both treatments have been established as standard-of- approval suggests that the costs for both are outside care treatments for second-line MM; however, best practice acceptable parameters, at least in the UK setting, and has not yet been determined. Cost is certainly not the only despite the UK being a free-priced market, our analysis factor in determining if, when, and how a drug should be has shown that it is a relatively low-cost one. used, although it is a vital component. By having a better understanding of the difference in cost, payors can make more informed decisions about how to prioritise MM treatment.8 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.
  9. 9. References 1. Bortezomib label: http://www.velcade.com/Files/PDFs/VELCADE_PRESCRIBING_INFORMATION.pdf accessed on 10 January 2011 2. Lenalidomide label: http://revlimid.com/pdf/REVLIMID_PI.pdf accessed on 6 January 2011 3. NICE guidance on bortezomib: http://www.nice.org.uk/nicemedia/live/11869/38001/38001.pdf accessed on 6 January 2011 4. NICE guidance on lenalidomide: http://www.nice.org.uk/nicemedia/live/11898/44812/44812.pdf accessed on 6 January 2011 5. UK pricing and reimbursement data taken from the IHS OncoInsight Market Access Database, accessed on 5 January 20119 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.
  10. 10. Meet the Analysts Gustav Ando Sophia Walker Director, Healthcare and Pharma, IHS Senior Healthcare Analyst, IHS Gustav Ando leads the Healthcare and Pharma Sophia Walker is a Senior Analyst in the advanced Practice at IHS. Formerly a healthcare analyst, he markets team, with a focus on the oncology has extensive experience in the fields of market service. She has an extensive background in access, therapeutic development, drug safety, oncology clinical trials, as well as an expertise in emerging markets and health outcomes. market access and pricing and reimbursement. Milena Izmirlieva Praful Mehta Senior Manager, Healthcare and Pharma, IHS Senior Healthcare Analyst, IHS Milena Izmirlieva is a Senior Manager in the Praful Mehta is a practice leader within the Healthcare and Pharma practice at IHS. Her IHS therapeutic area services. Praful has been a areas of expertise include market access, pricing long-time advisor to senior tea ms within and reimbursement, generics and biosimilars, the pharma industry on issues of market corporate strategies, and pharma promotion competitiveness, business integration and and advertising. commercialization strategies.10 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.
  11. 11. About the World Markets Oncology Service The data used in this report was taken from the IHS OncoInsight ƒ Plan and forecast budgets Market Access Database, a key component of our World ƒ Stay up to date with recent industry developments and Markets Oncology service. market trends Subscribers get access to: > Learn more about World Markets Oncology ƒ The IHS OncoInsight Market Access Database: 55 sets of data for more than 20,000 approved drugs and R&D drugs for cancer The IHS Global Insight Healthcare and ƒ Same-Day Oncology News Analysis: major oncology events Pharmaceuticals Practice by cancer area, drug class, and regulatory profile, plus a The IHS Global Insight Healthcare and Pharmaceuticals practice weekly bulletin summarizing the week’s analysis provides a portfolio of intelligence solutions to optimize the ƒ Over 200 cancer area, drug class, and regulatory profiles performance of companies and organizations across the ƒ Special Reports on industry events and trends pharmaceutical, biotech, and generics sectors. ƒ Phone access to our research analysts Our key focus is to provide actionable insights to support strategic How can World Markets Oncology help you? decision making, particularly in the fields of market access, ƒ More effectively evaluate market opportunities and risks pricing and reimbursement (P&R), emerging markets, generics ƒ Monitor competitors and customers with accuracy strategies, therapeutic development pathways, and general competitive intelligence. ƒ Make informed decisions driven by insight ƒ Assess the impact of a changing regulatory environment > Find out more about our healthcare and pharmaceuticals practice11 | A Cross-country Cost Comparison of Second-Line Multiple Myeloma Treatments | Copyright © 2011, IHS.

×