Research Article

Cost-Effectiveness of Olaratumab in Combination with Doxorubicin for Patients with Soft Tissue Sarcoma in the United States

Table 2

Key input parameters.

Drug prices (source: Micromedex Solutions [30])a

DrugVial size and price per vialVial size and price per vialMinimum price per milligram
Olara190 mg vial $896.80500 mg vial $2,360.00$4.72
Dox20 mg vial $5.4450 mg vial $13.60$0.84
Dex250 mg vial $163.46500 mg vial $326.91$1.10
Ifo1000 mg vial $29.783000 mg vial $89.34$0.05
Mesna1000 mg vial $15.25$0.07
G-CSF6 mg vial $3,898.41$859.28
Gem200 mg vial $8.091000 mg vial $40.44$0.09
Doc20 mg vial $47.7680 mg vial $191.04$8.42
PLD20 mg vial $969.0050 mg vial $2,422.50$48.45
DTIC100 mg vial $4.36200 mg vial $8.72$0.10

Administration costs (per administration)
(source: HCPCS codes from essential RBRVS [31])

DrugAdministration day and costAdministration day and costAdministration day and cost
Olara + DoxDay 1 of cycles 1–4 (Olara + Dox) $379.76Day 1 of cycles 5–8 (Olara + Dox + Dex) $476.21Day 8 of all cycles (Olara only)b $208.79
DoxDay 1 of cycles 1–4 (Dox) $170.98Day 1 of cycles 5–8 (Dox + Dex) $379.76
AIMcDays 1, 2, and 3 of cycles 1–4 (AIM) $572.11Days 1, 2, and 3 of cycles 5–6 (AIM + Dex) $668.56Day 4 (Ifo + mesna only) $476.21
GemDocDay 1 (Gem) $252.63Day 8 (GemDoc) $349.08
PLDDay 1 (PLD) $208.79
MAIDDays 1, 2, and 3 (MAID) $772.13Days 1, 2, and 3 (MAID + Dex) $868.58
G-CSFDays 5 and 9 $115.08

Monitoring
(sources: clinical expert opinion; HCPCS codes from essential RBRVS [31])

Resource categoryCost per visit and testsFrequency of visitsCost per resource use
Follow-up visitCost per visit $723.79dEvery 3 months for 5 years, every 6 months until 7 years, annually thereaftere
Cardiac monitoringMultigated acquisition scanEvery Dox cyclee$366.06f
Cardiac monitoringEchocardiographyEvery second Dox cyclee$352.36f

Total cost of all subsequent lines of active systemic therapy
(sources: JGDG trial in Lilly data on file [32]; HCPCS codes from essential RBRVS [31]g)

DrugDrug costAdministration costAE costs
Olara + Dox patients$5,418.43$3,972.43$21,303.98
Patients receiving comparator interventions$5,515.48$4,043.58$21,303.98

AE = adverse event; AIM = ifosfamide + doxorubicin + mesna; BSA = body surface area; Dex = dexamethasone; Doc = docetaxel; Dox = doxorubicin; DTIC = dacarbazine; G-CSF = granulocyte-colony stimulating factor; Gem = gemcitabine; GemDoc = gemcitabine + docetaxel; HCPCS = Healthcare Common Procedure Coding System; Ifo = ifosfamide; MAID = mesna + doxorubicin + ifosfamide + dacarbazine; Olara = olaratumab; Olara+Dox = olaratumab + doxorubicin; PLD = pegylated liposomal doxorubicin; RBRVS = resource-based relative value scale; SD = standard deviation; UK = United Kingdom. aThe mean (SD) weight and BSA were assumed to be 85.8 (23.0) kg and 2.0 (0.3) m2 (JGDG trial, Lilly data on file [33]). Drug costs were calculated by assuming that unused drug in opened vials is wasted. The distribution of weight and BSA was simulated, and the number of vials needed for each weight per BSA category was determined and costed. bAlso day 1 after Dox discontinuation (Olara only). cAssumed to be given in an outpatient setting. dOutpatient visit and physical examination ($223.03); computerized tomography scan ($352.78; 92% of visits); positron emission tomography ($1,072.98; 9% of visits); magnetic resonance imaging ($584.29; 14% of visits). Source of unit costs: Essential RBRVS [31] HCPCS codes; usage of imaging based on Lilly observational study [32] (UK data). eBased on clinical expert opinion. fEssential RBRVS [31] HCPCS codes. gCosts were estimated based on subsequent lines of treatment observed after the investigational therapy in the JGDG study in each treatment arm. Subsequent therapies included DTIC, GemDoc, Dox, eribulin, everolimus, Gem, Ifo, Ifo + mesna, pazopanib, and trabectedin. The average cost of treatments in the Olara + Dox arm was applied for both arms. The total cost of all subsequent treatments recorded in the trial was estimated based on the proportion of patients receiving each regimen and duration of therapy recorded. Drug and administration costs were estimated assuming a 3-week treatment cycle and dosing schedules from clinical studies; unit costs were from Micromedex Solutions [30] and HCPCS codes from Essential RBRVS [31].