BACKGROUND: Multiple myeloma (MM) is the second most prevalent hematologic cancer in the United States (US). Despite significant advances made in the treatment of MM, prognosis remains poor for most patients due to the refractory nature of the disease. Selinexor (XPOVIO; Karyopharm Therapeutics, Inc.) has been approved in the US for the treatment of adult patients with penta-refractory MM. Objective: To estimate the projected budgetary impact of adopting selinexor in the intended patient population from the perspective of a third-party payer (private payer or Medicare) in the US.
METHODS: A budget impact analysis was conducted in one-year increments for the first 3 years after the introduction of selinexor as a treatment for patients with penta-refractory MM. The number of eligible patients was derived from US epidemiology statistics in the Surveillance, Epidemiology, and End Results (SEER) program, healthcare databases, and published literature. Total annual treatment costs (2018 US dollars) were calculated as the sum of drug costs and costs of treating serious adverse events (AEs; grade ≥3), along with ongoing best supportive care costs. Dosing, duration of treatment, and rates of AEs were obtained from the prescribing information for selinexor.
RESULTS: In a hypothetical private payer plan with one million members, the annual number of selinexor eligible patients was estimated to be 4. In the base-case analysis, selinexor was associated with a per member per month (PMPM) cost of $0.0103 in year 3, assuming a market uptake of 64%. The budget impact remained modest in a scenario analysis in which the selinexor eligible population included patients with triple-class refractory MM regardless of the line of therapy. The estimated PMPM cost in year 3 for this scenario analysis was $0.0388 with 16 eligible patients. The model showed comparable sensitivity to treatment duration, wholesale acquisition cost for selinexor, and year 1 uptake, when base-case inputs were varied by ±10%. The base-case analysis was also conducted from the Medicare perspective with a population of 51 million lives. The introduction of selinexor was associated with a PMPM cost of $0.0078 in year 3, assuming a market uptake of 64% and 159 eligible patients. Taking into consideration budget-impact analyses for other therapies in relapsed or refractory MM, this analysis suggests that selinexor would result in a limited budget impact for a third-party US payer.
CONCLUSIONS: The model estimates a small and manageable budget impact of adopting selinexor into a third-party US payer plan, given the low prevalence of penta-refractory MM.
