BUDGET IMPACT AND INCREMENTAL SURVIVAL BENEFIT OF ERIBULIN MESYLATE AS A TREATMENT FOR METASTATIC BREAST CANCER IN BRAZIL

OBJECTIVES The objective of this study was to estimate the incremental Budget Impact (BI) and survival benefit of utilizing eribulin for treatment of Metastatic Breast Cancer (MBC) in patients with 2-5 prior chemotherapy regimens including anthracycline and taxane. METHODS Epidemiology was derived from 2013 CancerMPact report and National databases (FOSP and INCA). Treatment of Physician’s Choice (TPC) arm included capecitabine, gemcitabine, vinorelbine, docetaxel and paclitaxel.   TPC market shares, efficacy and Adverse Events (AE) data were taken from Phase III clinical trial. Total costs comprised of drug costs, administration costs, direct medical and AE costs. A micro-costing analysis of resource utilization for AE treatments and disease management pre and post progressions was performed.  Local Brazil tariffs for each costs unit were applied to an Excel-based model to compare total costs and survival rates with and without eribulin for MBC patients across a 5-year horizon from private payers perspective (assumed to cover 25% of Brazil population).   RESULTS Applying an MBC prevalence rate, proportion of patients with active disease and treated with 3^rdline chemotherapies the model estimates up to 801 patients treated with eribulin out of 3864 eligible patients over 5 years. Assuming eribulin market share of 2%, 5%, 9%, 14% and 20% in years 1, 2, 3, 4 and 5, the BI is R$294K, R$741K,  R$1345K, R$2111K and R$3043K (net increase of 0.12% - 1.21%).  The main cost offsets include the displacement of more widely-used TPC therapies.  Eribulin MBC treatment in Brazil is estimated to yield an incremental 245 progression free patient years and 408 life years in population covered by private insurance.  CONCLUSIONS Given the limited number of effective treatment options available to patients receiving third line chemotherapy, eribulin represents a much needed therapy option for this population. With additional survival benefits eribulin represents an effective innovative approach to MBC management.