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Forecasting outpatient pharmaceutical expenditure for cancer treatment in Germany

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Die Ausgaben der gesetzlichen Krankenkassen für Krebsmedikamente werden bis zum Jahr 2016 um 17 Prozent auf 3,25 Milliarden Euro steigen. Zu diesem Ergebnis kommt eine Studie der Techniker Krankenkasse (TK) und des Hamburger Center for Health Economics.
Weitere Informationen unter: http://www.tk.de/tk/pressemitteilungen/politik/689904

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Forecasting outpatient pharmaceutical expenditure for cancer treatment in Germany

  1. 1. figure 3: Forecasted pharmaceutical expenditure for outpatient cancer treatment of SHI in 2016 60 458 50 45 342 136 1,163 218 264 10 343 164 0 200 400 600 800 1,000 1,200 1,400 [million €] Forecasted pharmaceutical expenditure for outpatient cancer treatment of SHI in 2016 Forecasting outpatient pharmaceutical expenditure for cancer treatment in Germany Goentje-Gesine Schoch1, Svenja Blank1, Melanie Tamminga1, Tim Steimle1, Tom Stargardt2 1Drug Department, Techniker Krankenkasse, Hamburg, Germany 2Hamburg Center for Health Economics, University of Hamburg, Hamburg, Germany To allow budgeting of pharmaceutical expenditure for cancer drugs in Germany, we forecasted future outpatient pharmaceutical expenditure for cancer treatment from the perspective of the statutory health insurance (SHI) for 2016. The Techniker Krankenkasse (TK) is a large German sickness fund with more than 8.2 million insured. Based on routine data of the TK from April 2012 to March 2013 we calculated current pharmaceutical expenditure for 12 cancer indications (CPE). Indications were classified according to ICD- 10 [table 1]. If a new drug is supposed to replace existing pharmaceuticals we subtracted costs of replaced drugs [table 2]. If a new drug is supposed to be given additionally, we added costs of new drugs. For calculations, we assumed that newly launched drugs will reach on average a diffusion of 20% of their market potential until 2016. Market potential was defined as for a new drug eligible patients. To assess the impact of new drugs, we obtained expert opinion by IMS Health on (a) the timing of drug launches in the German cancer market (b) the expected prices of new drugs (c) the extent to that new drugs will replace existing pharmaceuticals. To forecast the pharmaceutical expenditure until the end of 2016 we used CPE of TK. We incorporated trends in membership to TK and demographic changes. We incorporated costs of new cancer drugs that will be launched until the end of 2016. Finally, to extrapolate results to whole SHI, we adjusted for differences in demographics of insured between TK and SHI using publicly available data, i.e. KM6 statistics. We assumed an increase of average age in SHI and a nearly unchanged number of insured. We performed a Monte Carlo (MC) simulation using the examples of NSCLC and Breast Cancer to consider the uncertainty of our model. We chose NSCLC because we expect the highest number of new drugs for this indication and expect new drugs to replace existing pharmaceuticals as well as to be given additionally [table 2]. We also chose Breast Cancer because we expect the highest pharmaceutical expenditure of the 12 cancer indications in 2016 to be spent for Breast Cancer [table 2]. We approximated the annual expenditure in 2016 based on TK data from April 2012 to March 2013. Therefore we defined probability distributions and generated random values by a sample size of 100,000 for (a) the expected monthly costs of new drugs (b) the extent to that new drugs will replace existing pharmaceuticals (c) the rate of market penetration. We used Statistical Analysis System (SAS) version 9.3 for computation of MC simulation. According to our model, SHI outpatient pharmaceutical expenditure for these 12 cancer indications was overall million €2,780 in 2012, i.e., 9.5% of total outpatient pharmaceutical expenditure [fig.1 ]. 26 new cancer drugs were identified to be launched in Germany until the end of 2016 [table 2].10 of them will at least partly replace existing pharmaceutical treatments [table 2]. OBJECTIVES METHODS RESULTS disease ICD-10 Gastric Cancer C16 Colorectal Cancer (CRC) C18-21 Hepatocellular Carcinoma (HCC) C22 Gastro-Intestinal-Stromal-Tumor (GIST) C26.9/C49.9 Lung Cancer (NSCLC) C34 Melanoma C43 Breast Cancer C50 Ovarian Cancer C56 Prostate Cancer C61 Thyroid Cancer C73 Multiple Myeloma (MM) C90.0 Chronic Lymphocytic Leukemia (CLL) C91.1 In 2016, we expect annual outpatient pharmaceutical expenditure for the 12 cancer indications to increase by 17.2% to million €3,258 [fig. 2]. According to our model, Breast and Colorectal Cancer will cause the highest expenditure [figure 3]. The Monte Carlo simulation revealed a median of million €322 for forecasted expenditure for NSCLC in 2016 and €1,231 for Breast Cancer respectively [figure 4]. 50,000 out of 100,000 simulations showed results from million €305 (Q1) to €351 (Q3) for NSCLC and from million €1,210 (Q1) to 1,253 (Q3) for Breast Cancer. The expected increase in costs for cancer drugs are a financial challenge for German SHI. Whether benefit of new drugs and expected costs can be considered fair value needs to be investigated elsewhere. million €2,780 billion €29.2 Outpatient pharmaceutical expenditure of SHI in 2012 cancer drugs total outpatient pharmaceutical expenditure new drug indication replacement ramucirumab Gastric Cancer - regorafenib CRC 60% of aflibercept ADI-PEG 20 HCC - regorafenib GIST - afatinib Lung Cancer (non-small cell) 20% of pemetrexed dacomitinib 60% of erlotinib ganetespib - necitumumab - nintedanib - dabrafenib Melanoma 50% of vemurafenib (dabrafenib and trametinib together) trametinib nivolumab - talimogene laherparepvec - trastuzumab emtansine Breast Cancer - nintedanib Ovarian Cancer 10% of bevacizumab trebananib 10% of bevacizumab vintafolide - radium-223 dichloride Prostate Cancer - 10% of cabazitaxeltasquinimod lenvatinib Thyroid Cancer (differentiated) - cabozantinib Thyroid Cancer (medullary) 30% of vantedanib carfilzomib Multiple Myeloma - elotuzumab - plitidepsin - pomalidomide - ibrutinib Chronic Lymphocytic Leukemia - idelalisib - obinutuzumab 50% of rituximab CONCLUSIONS table 1: Regarded cancer diagnoses figure 1: Outpatient pharmaceutical expenditure of SHI in 2012 table 2: New cancer drugs and indications figure 2: Outpatient pharmaceutical expenditure for cancer treatment of SHI in 2012 and 2016 2,780 3,258 0 500 1,000 1,500 2,000 2,500 3,000 3,500 2012 2016 [million €] Outpatient pharmaceutical expenditure for cancer treatment of SHI in 2012 and 2016 demographic changes (million €82) new drugs (million €526) already launched drugs (million €2,650) figure 4: Monte Carlo simulation for annual expenditure for NSCLC and Breast Cancer of SHI in 2016 0 200 400 600 800 1,000 1,200 1,400 NSCLC Breast Cancer [million €] Monte Carlo Simulation for annual expenditure for NSCLC and Breast Cancer of SHI in 2016 279 1,412 1,119 1,438

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