PCN18 A Budget IMPACT Analysis of Fixed Dose Combination of Netupitant and Palonosetron (NEPA) for the Prevention of Chemotherapy-Induced Nausea and Vomiting (CINV) in Malaysia

We assessed the budget impact of adopting NEPA compared with combinations of aprepitant and 5HT3 agents from the perspective of the Malaysian Ministry of Health (MOH) for patients receiving highly emetic chemotherapy (HEC). A budget-impact model (BIM) was developed to estimate the impact of the introduction of NEPA on the healthcare budget in over a five-year horizon (2020-2024) from the payer’s perspective. Target population was estimated by combining data of new cases of cancer in Malaysia, expert opinion from a local survey and historical cancer incidence data in Malaysia resulting in an estimated 13,227 in HEC in 2020. Comparators and their respective posology were chosen following NCCN guidelines and local practice. Market shares were estimated using prescription data in 2019 and an assumed uptake of 0% to 35% (2020-2024) from the combination aprepitant and granisetron to NEPA in HEC. Drug costs and cost incurred to emetic events [125.11 Ringgit] were considered in this analysis. Drug costs were based on government hospital price in Malaysia. Cost incurred to the management of emetic events were determined based on published literature and expert opinions for the use of inpatient and outpatient care and rescue medication. The theoretical introduction of an NEPA resulted in projected net budget-savings of 890,948 Ringgit over 5 years in HEC, of which 57% was attributed to reduced CINV episode management. Such savings, could potentially fund treatment for an additional 525 patients with NEPA over five-years in HEC. The introduction of NEPA could represent tangible cost-saving potential for healthcare payer in Malaysia, mainly driven by a reduction in CINV management costs. The ability to realise these benefits will depend on price agreed and capacity to treat larger number of patients. These savings could be used to treat additional patients suffering from CINV with NEPA.