OBJECTIVES: With recent drug approvals in prostate, melanoma and lung cancers, determining the uptake rate is important to understand their budgetary impact for national and private payers. This research describes the patterns in uptake of novel anti-cancer agents in the US and discusses the importance of developing time-dependent budget/cost-effectiveness models.

METHODS: Unique patients initiating therapy approved between 01/01/2011-12/31/2016 for prostate, melanoma and lung cancer were counted by quarter (Q) in the Symphony Health pharmacy and medical claims database (≥ 1 Rx claim and ≥ 1 medical claim for indication-specific diagnosis). Mean time to peak utilization was assessed. Trends in utilization were evaluated using linear regression. Model fit was based on r RESULTS: Mean years from approval to peak utilization was: abiraterone(abi)=4, enzalutamide(enza)=4.5, ipilimumab(ipi)=2.3, dabrafenib/trametinib(dab/tra)=3.5, afatinib(afa)=4.5, crizontinb(criz)=4.5. A quadratic model (x) showed a downward trend in abi use beginning in 2015 Q2 (r=0.97). A cubic model (x) for enza showed stable rates since 2016 Q3 (r=0.98). Expanded indications increased the slope of the uptake curves for both drugs. Use of ipi began to decline in 2014 Q3 (x,r=0.84) at the time of approval of nivolumab. Similarly, utilization of dab/tra appears (x,r=0.95) to be now declining(42% less dab/tra from 2015 Q1-2016 Q4), approximately 2 quarters following launch of nivolumab. Afa use appeared to begin to decline(x,r=0.96) while criz appeared stable (x,r=0.96).

CONCLUSIONS: This research demonstrates that it takes several years from approval to attain peak market share. Uptake is not a linear process and market forces drive utilization patterns. Payers, whether national or private, should request time-dependent uptake factors in the calculation of budget impact models or forecasts to accurately reflect rates of adoption. Historical data can be used to inform such models.