Per-Member Per-Month (PMPM) Expenditure Value in Oncology: Updating a Focused Literature Review

OBJECTIVES: Payer listing of new technology and healthcare decision-making in the United States (US) often relies on economic burden value-propositions and budget impact information. US-focused budget impact models commonly provide results using the per-member per-month (PMPM) expenditure. Evaluating PMPM costs can be challenging. The objective of this review was to update a previous review which investigated the factors affecting as well as determining the distribution of PMPM values in oncology.

METHODS: A targeted literature search was performed and various PMPM data in oncology from studies published since the year 2000 were chosen. All studies were conducted in US payer perspective. PMPM results were assessed and compared to identify their primary drivers.

RESULTS: Of 81 identified, 40 studies met inclusion criteria. Time-horizons varied from 1-5 years and there was a common assumption of 1-million-members in the PMPM-related health plans. Of the reported PMPM values, 23.5% were in lung cancer, followed by 11.8% in leukemia as well as 11.8% in prostate cancer. In addition to disease incidence and drug cost, primary factors affecting PMPM were time-horizon, geographical variables, baseline population characteristics, disease type, market share, and survival after new treatment. Additionally, it was determined that PMPMs were positive in some studies while negative in others, depending on the indication and intervention type, and that non-curative new treatments with prolonged survival led to higher PMPM. In screening-focused literature, there was considerable usage of PMPM with the intention to show usefulness, reduced mortality, or cost-savings.

CONCLUSIONS: This is an update to the first literature review of studies that reported PMPM values in oncology to quantify the expenditures of interventions. It is important to remember and consider that the situation, baseline characteristics, and underlying diseases play an important role when evaluating and determining an appropriate PMPM.