Abstract LB-291: Budget impact analysis of ttfields + platinum-based therapy for first-line malignant pleural mesothelioma
Authors: Wang Bruce C. , Furnback Wesley , Proescholdt Christina , Chavez Gordon 
Published: September 2020

Objective: To estimate the financial and survival impact of introducing TTFields in combination with pemetrexed and a platinum agent to the formulary of a large U.S. health plan for first-line treatment of malignant pleural mesothelioma (MPM).

Methods: An open-cohort health economic model was constructed to compare pre-TTFields approval and post-TTFields approval scenarios to estimate the incremental costs and survival outcomes for MPM patients treated with first-line therapy. A theoretical U.S. health plan covering 45 million lives was utilized. The pre-approval scenario considered first-line treatments of pemetrexed + cisplatin, pemetrexed + cisplatin/carboplatin + bevacizumab, pemetrexed monotherapy, gemcitabine + cisplatin, gemcitabine monotherapy, and vinorelbine monotherapy. Post-approval included all of the previous treatments as well as TTFields + pemetrexed + cisplatin/carboplatin. The model assumed 70% of incident MPM patients were treated with first-line therapy and 30% of eligible patients were treated with subsequent therapy. Subsequent therapy included pemetrexed, gemcitabine, and vinorelbine monotherapies as well as nivolumab + ipilimumab. The market share of TTFields + pemetrexed + cisplatin/carboplatin rose linearly from 9% to 22.5% over the five year time horizon in the post-approval scenario. Overall survival and adverse event rates for all regimens were sourced from clinical trial data, and dosing assumptions were from trial data, NCCN guidelines, and package inserts. Drug/device, administration, adverse event, and subsequent therapy (30% of eligible patients) costs were considered in the model and sourced from Medicare and Novocure. All costs are presented in 2019 USD and discounted at 3%. Results: There were 155 incident MPM patients treated with first-line therapy annually in the model. When compared to the pre-approval scenario the post-approval scenario resulted in 0.9 additional (1.07% increase) patients surviving at the end of year one and 13.8 additional (7.10% increase) patients at the end of year five. The forecasted budget impact ranged from $570,875 in year one to $2,770,856 in year five, for a total budget impact of $8,417,333 over the five-year time horizon. The budget impact was driven by an increase in drug and device costs of $8,338,341 and subsequent therapy costs of $1,242,548, which were slightly reduced by lower drug administration costs ($104,415), and adverse event costs ($1,059,141). The total per member per month (PMPM) cost increased by $0.003 over the five-year time horizon. Conclusion: The increase in the budget of a large U.S. health plan due to the introduction of TTFields as a first-line MPM treatment was relatively small on a PMPM basis and provided a notable survival benefit over the five year time horizon.

Citation Format: Bruce C. Wang, Wesley Furnback, Christina Proescholdt, Gordon Chavez. Budget impact analysis of ttfields + platinum-based therapy for first-line malignant pleural mesothelioma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr LB-291.