OBJECTIVES: Economic evaluations as well as healthcare resource utilization (HCRU) studies often present outcomes using the per-member per-month (PMPM) expenditure. The objective of this review is to examine the landscape and factors affecting PMPM costs in non-oncology.

METHODS: A targeted literature search was conducted in PubMed to identify studies reporting PMPM costs in non-oncology. Studies published between 2012 and June 30, 2022 that included PMPM results were assessed to examine factors influencing their values.

RESULTS: Out of the 502 records identified, 108 were eligible for inclusion. An overwhelming majority of the studies were from the US (106) and the remaining studies were from Canada (1) and Malaysia (1). Sixty-four records described economic evaluations, whereas 44 reported HCRU, including 41 retrospective and three prospective observational studies. Diabetes (17%) was the most studied condition, followed by cardiovascular and autoimmune diseases (12%). Time horizon ranged from 1 month to 15 years. Most economic evaluations were conducted from a commercial payer perspective (64%), followed by public payer (30%). Outcomes were typically modelled using a budget impact model (63%), with some investigators utilizing decision trees to analyze over short-term horizons (19%). Incremental PMPM values in budget impact studies ranged from -$3.13 to $7.72. Sensitivity analyses reported PMPM costs to be most sensitive to market share uptake and drug prices. Among HCRU studies, the highest reported mean PMPM cost was $25,517 for patients with spinal muscular atrophy. Pharmacy, inpatient, and outpatient costs were the main drivers of PMPM expenditures.

CONCLUSIONS: To our knowledge, this is the first targeted review of studies to analyze PMPM expenditure in non-oncology. PMPM costs varied significantly among studies with different indication and methodology. Therefore, PMPM estimates should be carefully interpreted based on perspective, study design, and disease area. Drug acquisition costs as well as market share are important drivers of PMPM costs.