OBJECTIVES: The objective of this review was to examine the budget impact analysis (BIA) of treatments used in metastatic non-small cell lung cancer (mNSCLC) from the US payer perspective.

METHODS: A literature review of the PubMed and Embase databases was conducted. Full-text and conference abstracts published in the past 10 years up til 10/28/2022 were considered. BIA studies reporting results of treatments in mNSCLC from the US payer perspective were included. Studies on biomarker testings were excluded. Data extracted from studies included were study characteristics (first author, year of the study, study type, treatment, model parameters, and patient population), the endpoints, and results.

RESULTS: A total of 9 studies reporting BIA results of treatments in mNSCLC from the US payer perspective were identified. Treatments studied included EGFR inhibitors (n=4), MET inhibitors (n=2), RET inhibitors (n=1), taxanes (n=1) and PD-1 inhibitors (n=1). A majority of the studies simulated the change in total direct costs of adding the treatment(s) to a hypothetical insurance health plan (either commercial, Medicare or mixed) except for Hess 2016 and Goldstein 2017 which reported models for an institutional and Medicare payers respectively. Time period of the BIA models ranged from 1 to 5 years with 3 years as the most commonly reported. Direct costs modeled typically included drug acquisition and administration, treatment monitoring, disease and adverse event management, post-progression care and end of life costs. Endpoints reported may include total annual cost, per patient per year (PPPY) costs or per member per month (PMPM) costs. One-way deterministic sensitivity analyses of the model inputs were conducted in 7 studies. Total annual cost reported were as high as $3.4B for Medicare payer.

CONCLUSIONS: A significant amount of heterogeneity exists with how BIA for treatments used in mNSCLC from the US payer perspective were conducted and reported.