Cost Efficiency of Trilaciclib, A First-in-Class Kinase Inhibitor Providing Multilineage Myeloprotection, and Expanded Budget-Neutral Access to Multilineage Myeloprotection for Extensive-Stage Small Cell Lung Cancer Patients

Abstract

Specific Aims: To determine the cost-efficiency of multilineage treatment with trilaciclib versus monolineage cytopenia prophylaxis/management in a panel of 10,000 ES-SCLC patients, and how accrued savings can be re-allocated budget-neutrally to provide additional ES-SCLC patients with trilaciclib treatment while undergoing myelotoxic cancer treatment. Methods: Economic simulation model from a 10,000-payer perspective in Microsoft Excel with the following inputs: cost of trilaciclib; cost of triple monolineage prophylaxis/management with granulocyte colony-stimulating agents (GCSFs) (neutropenia), erythropoiesis-stimulating agents (ESAs) (anemia), platelet transfusion and romiplostim (thrombocytopenia). Calculations were based on an ideal patient with non-end-stage renal disease and ES-SCLC, weighting 65 kilograms, measuring 180 centimeters. Pricing data was sourced from the United States Centers of Medicare and Medicaid Services (Average Sale Price). Results: There was one simulation (darbepoetin-alfa, pegfilgrastim biosimilars, and romiplostim) that was shown to have a cost efficiency of 12.5% in the treatment of combination anemia, neutropenia, and thrombocytopenia. For this simulation trilaciclib had a savings of $549,816 per cycle per 10,000 patients. When extrapolated to six full cycles of chemotherapy treatment, a savings of $3,298,896 which can be reallocated into 469 individual cycles of trilaciclib or 78 full six cycle treatments. Conclusions: Trilaciclib has the potential to provide savings benefits when treating myelosuppressive events. However, due to factors in the current market it is not very compelling to use at this time. Once trilaciclib gains expanded indications for use, a generic equivalent becomes available, or market competition changes the current prices of myelosuppressive treatments, further studies can be performed to reassess potential economic benefit of its use.