Budget impact model of subcutaneous compared with intravenous rituximab in the treatment of diffuse large B-cell and follicular CD-20+ non-Hodgkin lymphoma patients in the Brazilian private healthcare system

Abstract

Objective: To estimate the budgetary impact of the introduction of subcutaneous compared with intravenous rituximab in the Brazilian private healthcare system to treat diffuse large B-cell CD-20+ non-Hodgkin lymphoma (NHL) patients. Methods: Perspectives were the private healthcare system (PHS), a big, medium and small HMO. We used data from National Regulatory Agency for Private Health Insurance and Plans to obtain the mean number of patients per HMO size. Incidence and survival data of diffuse large B-cell CD-20+ NHL were applied to reach the eligible population. A survey with 28 HMOs mapped fees, pricing sources and reference tables used for reimbursement. A multidisciplinary team estimated the resource use. Direct medical costs were included; drugs and material prices were obtained from published sources. Time horizon was 5 years and market share considered the uptake of subcutaneous rituximab starting with 20% in the first year, increasing to 100%. Results: In 5 years, 3,846 diffuse NHL patients were estimated for the PHS, 35 for big HMO, 5 for medium HMO, and 5 for small HMO. Results showed that the progressive incorporation of subcutaneous rituximab can save up to 15.8 million BRL, 144.3 thousand BRL, and 20.4 thousand BRL in the PHS, a big HMO, and in medium/small HMOs, respectively. Differences among fees and material costs of subcutaneous and intravenous administration were the main drivers of results. Conclusion: Compared with the intravenous administration, subcutaneous rituximab can save up to 15.8 million BRL costs in the NHL treatment in the Brazilian PHS.