The cost-effectiveness of a NSCLC patient assistance program for pemetrexed maintenance therapy in People's Republic of China

Qiang Shi,1 Shanlian Hu,2 Wesley E Furnback,3 Gregory F Guzauskas,3 Jiejing Shen,1 Bruce CM Wang3 1Lilly Suzhou Pharmaceutical Company, Ltd., Shanghai, People’s Republic of China; 2Shanghai Health Development Research Center, Shanghai, People’s Republic of China; 3Elysia Group, Ltd., Taipei, Taiwan, Republic of China Background: Eli Lilly and the China Primary Health Care Foundation are currently implementing a patient assistance program (PAP) in China, which allows first-line nonsquamous non-small-cell lung cancer (NSCLC) patients who complete four cycles of pemetrexed induction therapy to receive free, continuous pemetrexed maintenance therapy.Objective: To estimate the cost-effectiveness of pemetrexed maintenance therapy vs basic standard care (BSC) and the economic impacts of providing a PAP for pemetrexed maintenance therapy to NSCLC patients who have completed pemetrexed induction therapy in a Chinese health care setting.Methods: We developed a novel decision-analytic model to evaluate the long-term costs and clinical efficacy of pemetrexed plus BSC vs BSC alone. We utilized a three-state (progression-free survival, progressed disease, and dead) partition survival model for both the clinical and economic aspects of the analysis. Cost and health utility estimates were derived from the literature. We performed a scenario analysis to estimate the real-world impact of introducing the PAP in China by comparing the use of the PAP vs non-PAP. Model uncertainty was evaluated using one-way and multivariate probabilistic sensitivity analysis.Results: Compared to BSC, pemetrexed plus BSC resulted in a gain of 0.22 years of life (95% credible range [CR]: 0.04–0.46) and 0.13 quality-adjusted life years (95% CR: 0.04–0.26) per patient, at an increased cost of $28,105 (95$22,720 to $48,646) without a PAP and$3,068 (95% CR: −$1,263 to$9,163) with a PAP. The incremental cost-effectiveness ratio for pemetrexed plus BSC vs BSC alone was cost-prohibitive at $222,700 for non-PAP, but cost-effective at$24,319 with a PAP.Conclusion: Our study suggests that maintenance pemetrexed therapy following pemetrexed induction for patients with advanced NSCLC is likely to be highly non-cost-effective in the absence of a PAP, but the pending implementation of the PAP promises to make it cost-effective, with a >90% probability of cost-effectiveness at a Chinese willingness-to-pay threshold per quality-adjusted life year. Keywords: non-small-cell lung cancer, pemetrexed, patient assistance program, cost–utility analysis, basic standard car

The cost reduction in hospitalization associated with paliperidone palmitate in the People’s Republic of China, Korea, and Malaysia

Chiun-Fang Chiou,1 Bruce CM Wang,2 Ronald Caldwell,3 Wesley Furnback,2 Jung-Sun Lee,4 Nathan Kothandaraman,5 SunKyoung Lee,6 Jin Wang,7 Fan Zhang8 1Regional Market Access, Janssen Asia-Pacific, Singapore; 2Elysia Group, LLC, Taipei, Taiwan; 3Department of Economics, University of Michigan, Ann Arbor, MI, USA; 4Department of Psychiatry, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea; 5Government Affairs, Johnson & Johnson Sdn Bhd, Selangor, Malaysia; 6Market Access, Janssen Korea Ltd, Seoul, Korea; 7Strategy and Development, Xian Janssen Pharmaceutical Co, Ltd, 8Medical Affairs, Xian Janssen Pharmaceutical Co, Ltd, Beijing, People’s Republic of China Background: Schizophrenia results in substantial health care utilization costs. Much of these costs can be attributed to health care use resulting from nonadherence to treatment, relapse, and hospitalization.Aims of the study: The objective of this research is to further estimate the health care resource utilization costs of patients with schizophrenia in the People’s Republic of China, Korea, and Malaysia with a specific focus on the reduction in hospitalization costs associated with the use of long-acting, injectable paliperidone palmitate (PP) relative to alternative treatment medications.Methods: The study focuses exclusively on the estimated reduction in hospitalization days following treatment with PP and the potential associated cost savings. Cost analysis was done using a payer’s perspective and only includes direct health care costs associated with hospitalization. Localized cost data were taken from published sources, and health care utilization was estimated based on a clinical study conducted in countries in the Asia-Pacific region. People’s Republic of China, Korea, and Malaysia had the highest number of patients enrolled in the clinical study, and thus were chosen for this research. Analysis looked at 12-month and 18-month periods following initial treatment with PP relative to a retrospective 12-month period utilizing alternative treatment medications.Results: Results suggest that reductions in hospital utilization cost over 12 months may occur through the use of PP relative to alternatives – ranging from 1,991 for the People’s Republic of China to 6,698 for Korea and $6,716 for Malaysia.Conclusion: Given the substantial costs associated with the treatment of schizophrenia both worldwide and in Asia, it is important to fully understand the costs and outcomes associated with various treatment options. In this research, we have specifically analyzed the direct health care cost savings associated with hospital utilization for patients taking PP relative to alternative treatment methods. The results suggest that reductions in hospital utilization cost were associated with PP treatment, likely largely due to increased adherence to treatment. Keywords: schizophrenia, antipsychotic treatment, health economics, cost savings&nbsp