PharmacoEconomics

An Exploratory Analysis of the Cost-Effectiveness of a Multi-cancer Early Detection Blood Test Compared with Standard of Care Screening in Ontario, Canada

Public Health Impact and Cost-Effectiveness of Routine and Catch-Up Human Papillomavirus Vaccination in Girls and Women in Selected Regions of China: A Model-Based Study

In China, human papillomavirus (HPV) vaccination for girls has been included in the National Immunization Program (NIP), providing free 2-valent HPV vaccine (2vHPV) for 13-year-old girls. This study assessed the public health impact and cost-effectiveness of routine 2vHPV/9vHPV for girls aged 13 years, with/without a catch-up strategy for females aged ≤ 26 years, in six cities with free 2vHPV programs but differing socioeconomic development across China (Wuxi, Suzhou, Guangzhou, Yuxi, Chengdu, and Shijiazhuang). A discrete-time Markov model was developed from the healthcare system perspective over a 100-year horizon. Routine (aged 13 years) and catch-up (aged ≤ 26 years) vaccination coverages were assumed at 90% and 70%, respectively. Model outputs included costs (2023 USD), quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and cases of HPV-related diseases averted. The willingness-to-pay (WTP) thresholds were set corresponding to 1 times the per capita GDP of each city. Scenario and sensitivity analyses were conducted to test robustness. Routine 9vHPV strategy prevented an additional 1921-9630 cases of cervical cancer, compared with the routine 2vHPV strategy. Furthermore, incorporating a catch-up strategy yielded a marginal additional reduction (29-176 cases by 9vHPV and 18-108 cases by 2vHPV) in cervical cancer. Under ideal pricing assumptions, the routine 9vHPV strategy was cost-saving and cost-effective across all six cities, compared with routine/routine plus catch-up 2vHPV strategies, with a cost saving of USD 1730-2792/1769-2817 per person, and a gain of 0.195-0.315/0.193-0.311 QALYs per person. Routine plus catch-up 2vHPV and 9vHPV strategies remained cost-effective in five and four cities, respectively. Notably, scenario analysis indicated at current domestic 9vHPV market price, the routine 9vHPV strategy remained cost-effective in six cities, while the catch-up strategy became cost-ineffective across all cities. The routine 9vHPV strategy may be cost-effective compared with the 2vHPV strategy in China. However, a 9vHPV catch-up strategy varies in cost-effectiveness by regional socioeconomic development.

The Budget Impact of Including Rucaparib on a US Payer Formulary for the Treatment of Patients with Metastatic Ovarian Cancer

A budget impact model was constructed to assess the incremental budget impact that rucaparib availability would have on a US health plan. An incremental budget impact was estimated over a 3-year horizon as the difference in total annual cost of treatment, with and without rucaparib available, for second-line maintenance, third-line treatment, and the combined maintenance and treatment settings. The hypothetical health plan includes one million covered lives, and commercial and Medicare lines of business. Alternative products included in the model were based on the National Comprehensive Cancer Network guidelines. The eligible patient population was estimated using an incidence-based approach. Modeled costs include drug acquisition, intravenous drug administration, required laboratory testing, and medical management of adverse events. In the maintenance setting, average total expenditures over 3 years were estimated to be US$1,465,043 with rucaparib versus US$1,461,350 without it as a treatment option; the average incremental budget impact was US$3693 (US$0.0003 per member per month [PMPM]). In the treatment setting, average total expenditures were estimated to be US$1,320,718 with rucaparib versus US$1,313,736 without it; the average incremental budget impact was US$6982 (US$0.0006 PMPM). Budget impact is smaller in commercial plans than Medicare because of the higher incidence of ovarian cancer in the over-65 population. The budget impact of adding rucaparib to the formulary for a health plan adds negligible PMPM costs of < US$0.001 in all tested settings and scenarios due to the small population eligible for therapy.