Johal S, Knight C, Bell MJ, Ralston S. Long-term fiscal implications of mepact in the treatment of high-grade nonmetastatic osteosarcoma: a budget-impact model and a lifetime tax perspective. Poster presented at the 2011 ISPOR 14th Annual European Congress; November 9, 2011. [abstract] Value Health. 2011 Nov; 14(7):A438.

OBJECTIVES: The addition of MEPACT as an add-on treatment to adjuvant chemotherapy in the treatment of high-grade non-metastatic osteosarcoma after macroscopically complete surgical resection has been shown to significantly increase overall survival of young patients. This study assessed the costs (drug and administration) and the long-term financial impact on the UK (UK) government of introducing MEPACT.

METHODS: Based on the cost of MEPACT and using survival rates derived from a clinical trial, we projected the net budgetary impact of MEPACT compared to no MEPACT. Further, we modelled the net tax contribution to the state of a surviving patient over a lifetime by subtracting direct government transfers that are made to the individual (child benefit, education etc) from the individual’s gross tax contribution based on average anticipated earnings.

RESULTS: Using UK incidence rates of osteosarcoma the model estimated approximately 54 newly diagnosed non-metastatic cases per year. Assuming that 38 doses of MEPACT (calculated from trial data) are added to the treatment regimen of 50% of patients at a cost of £91,189 , the expected 1-year cost would be UK £3,972k compared with £1,450k had all patients been treated without MEPACT. Administration costs accounted for 3% of total costs. The lifetime discounted value of net taxes from a 14 year old patient treated with MEPACT is £79,000. The breakeven age, defined as the point at which the net tax contribution becomes greater than zero, is approximately 41 years.

CONCLUSIONS: The additional budget impact due to MEPACT is mainly due to the cost of the drug. From the tax calculations, we conclude that investment in MEPACT does not negatively impact the long run fiscal budget of the UK government. Conversely, by taking a broader government perspective over an average lifetime, a surviving patient returns a positive net value to the State.

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