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Vinorelbine in patients with non-small lung cancer: budget impact analysis

OBJECTIVES: Vinorelbine in non-small lung cancer treatment was not available in Croatia through the Croatian National Health Insurance (CNHI) Positive Drugs List (PDL). The aim of our study was to analyse a possible impact of vinorelbine inclusion to the CNHI PDL according to the budget impact analysis (BIA). METHODS: A clinical guideline for vinorelbine reimbursement by CNHI is proposed according to evidence-based medical criteria and international guidelines. We have calculated the number of patients, potential candidates for vinorelbine treatment, and we have also developed BIA model for three-years period after the drug reimbursement. The share of vinorelbine has been estimated using market data from other countries and the price of vinorelbine has been calculated according to the Croatian MoH Pricing Ordinance. The total costs for CNHI have been calculated using a referent scenario (without vinorelbine) and a scenario with vinorelbine reimbursement. Monte Carlo simulation has been performed too. RESULTS: The total number of patients in non- small cell lung cancer stage III and IV is estimated to be 500-550 per year. Referent treatment costs are between 1, 705 EUR and 10, 974 EUR per patient (in case of biological treatment usage). Vinorelbine costs are 1, 044 EUR (monotherapy) and 1, 407 EUR (combination with cisplatin). Monte Carlo simulation showed annual cost of 1, 266, 794 EUR in scenario without vinorelbine and declining costs in scenario with vinorelbine from 77, 851 EUR less in the first year, 158, 611 EUR in the second and 237, 785 EUR in the third year. Cumulative three-year savings with vinorelbine introduction to the CNHI PDL are 474, 321 EUR. CONCLUSIONS: The inclusion of vinorelbine to national reimbursement list for patients with non-small lung cancer demonstrates significant savings and for patients provides additional clinical benefits as a new treatment option.

vinorelbine; non-small lung cancer; pharmacoeconomics; budget-impact analysis

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