This is the title of a recently published paper Clinicoeconomics and outcomes research With co-authors Jennifer Vaughn, Nadine Zawadzki, Shurui Zhang, Paul Pinkston, and David Wei. The subtitle is a comparison of later-generation TKIs versus imatinib from a patient and payer perspective. The gist is below:
Objective: To evaluate the financial impact of treating CML with later-generation TKIs relative to imatinib on US patients and payers.
Methods: The financial impact of later-generation TKIs (asiminib, bosutinib, dasatinib, nilotinib, and ponatinib) and imatinib was measured from the perspective of patients and payers before (2024) and after the Inflation Reduction Act (2025), respectively. Changes in patient annual out-of-pocket (OOP) costs of CML therapy by payer type (Medicare, Medicaid, and commercial) were used to indicate the financial impact on patients. Treatment costs per patient per year (PPPY) were measured as the weighted average cost in the indicated adult CML population derived using FDA label-based dosing and bulk acquisition costs. Annual OOP limits by payer types were determined through literature review. The financial impact from the payers’ perspective was estimated as the difference in monthly premiums based on the budget impact per member per month (PMPM).
Result: In 2025, the projected PPPY costs for imatinib ($22,430 across generic and branded products, based on market share) and for later-generation TKIs ($100,000 for all except dasatinib and nilotinib, which were $72,693 and $89,138, respectively) exceed the annual OOP limits under Medicare Part D, the average commercial plan, and the highest potential annual commercial plan. It’s done. OOP limit, resulting in no change in patient financial impact when switching from imatinib to a later-generation TKI. An all-payer mixed US health plan with 1 million members can expect 200 patients with Philadelphia chromosome-positive CML to be eligible for TKI therapy. Switching from imatinib to a later-generation TKI would increase the PMPM budget impact by between $0.76 and $4.23.
conclusion: The costs of both imatinib and later-generation TKIs were projected to exceed the annual OOP threshold in 2025, resulting in minimal change in OOP costs for insured CML patients. The impact on insurance premiums from TKI adoption is likely to be relatively modest.
You can read the full paper here.
