Presentation (CTI)

OBJECTIVES: To estimate the 3-year budget impact on a US plan of adopting OPSYNVI (macitentan/tadalafil single tablet combination therapy) for adult patients with WHO Group I PAH.
METHODS: A budget impact analysis was performed for a hypothetical 1,000,000-member plan which estimated the difference in costs for two scenarios: (1) a plan without OPSYNVI; (2) a plan with OPSYNVI. An analysis was conducted from both the US commercial and Medicare Advantage plan payer perspectives and included costs associated with drug acquisition, PAH-related hospitalizations, readmissions, ED visits, specialist visits, outpatient visits, and prostanoid initiation. Values for cost inputs and clinical outcomes were acquired from publicly available sources, published literature, and internal data. For the Medicare Advantage plan, drug acquisition costs were calculated based on what the payer incurred using the Medicare Part D Standard Benefit Design with IRA updates. Comparators included macitentan, ambrisentan, bosentan, tadalafil, sildenafil, and an ERA + PDE5i loose dose combination. Total costs were calculated for each scenario, and the net difference was calculated as the total budget impact.
RESULTS: The per-member per-month budget impact of OPSYNVI was less than $0.01 over 3 years for both a commercial and Medicare Advantage plan. One way sensitivity analyses were conducted which showed that the model’s key drivers were inpatient day costs, and inputs that affected the total eligible patient population.
CONCLUSIONS: Introducing OPSYNVI results in a minimal budget impact for both commercial and Medicare advantage plans. Despite its higher monthly costs, our model demonstrates that OPSYNVI could reduce hospitalization days, readmissions, and patients’ progression to prostanoid. Given that PAH is a rare, progressive, fatal disease, adding OPSYNVI to a plan’s formulary has negligible costs while potentially improving outcomes.