Ronquest N, Paret K, Lucas A, Ciepielewska M, Hagan M. A review of analyses evaluating the economic impact of oral versus intravenous formulations. Poster presented at the ISPOR 2022 Conference; May 14, 2022. Washington, DC.

OBJECTIVES: Drug formulations can have an impact on not only patients’ quality of life and disease outcomes, but also costs of care. We illustrate key cost considerations when conducting the economic evaluation of introducing oral formulations as an alternative to intravenous (IV) medications.

METHODS: A structured literature review was conducted using the PubMed database to examine methods used for quantifying the economic impact of introducing an oral pharmaceutical formulation as an alternative to IV medication. To illustrate the methods described in this review, a cost-calculator model was developed as a case study to quantify the impact of introducing an oral formulation of an existing IV medication for amyotrophic lateral sclerosis (ALS).

RESULTS: We identified 12 published evaluations of oral and IV formulations from 9 countries across a variety of disease areas. The studies used cost-effectiveness (n=9), cost-minimization (n=2), and cost-calculation (n=1) models. All 12 evaluations reported outcomes from the payer perspective, and societal perspectives were also incorporated in 3 of them. One study that incorporated the societal perspective, reported the indirect costs to be nearly 70% of the overall costs. Further, our case study estimated over 600 hours would be lost annually for patients with ALS and their family members due to IV administration and maintenance. When estimating the costs of a formulation choice, only a subset of the identified studies accounted for the effects of safety (n=5) or efficacy (n=4) differences on treatment costs. Many studies that omitted these aspects did not include rationale for their decisions.

CONCLUSIONS: We found significant design variations in published models that estimated the impact of an additional formulation option on the treatment costs to payers and the society. Models need to be accompanied with clear descriptions and assumptions on how different formulations may affect healthcare costs from the selected perspectives of the model.

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