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Supplemental material, sj-docx-1-aop-10.1177_10600280221146878 for Economic Evaluation of Three BRAF + MEK Inhibitors for the Treatment of Advanced Unresectable Melanoma With BRAF Mutation From a US Payer Perspective by Shiraz Halloush, Nimer S. Alkhatib, Abdulaali R. Almutairi, Mathias Calamia, Hala Halawah, Mavis Obeng-Kusi, Martin Hoyle, Omar Rashdan, Jim Koeller and Ivo Abraham in Annals of Pharmacotherapy

To assess the cost-efficiency and expanded access of three rituximab biosimilars versus the reference rituximab from the perspective of the Jordanian national health payer. A 1-year cost-efficiency and expanded access model of conversion from reference rituximab (Mabthera) to the approved biosimilars (Truxima, Rixathon, and Tromax) to assess five metrics: total annual cost to treat a hypothetical patient; head-to-head cost comparison; changes in patients’ access to rituximab; number-needed-to-convert (NNC) to provide an additional 10 patients access to a rituximab treatment; and relative amount of Jordanian Dinar (JOD) spent on rituximab options. The model included rituximab doses at 100 mg/10 ml and 500 mg/50 ml and considered both cost-saving and cost-wastage scenarios. Costs of treatments were based on the fiscal year 2022 tender prices received by the Joint Procurement Department (JPD). Rixathon was associated with the lowest average annual cost per patient (JOD2,860) across all six indications among all rituximab comparators, followed by Truxima (JOD4,240), Tromax (JOD4,365) and reference Mabthera (JOD11,431). The highest percentage of patient access to rituximab treatment (321%) was achieved when switching patients from Mabthera to Rixathon in the RA and PV indications. At four patients, Rixathon was associated with the lowest NNC to provide an additional 10 patients access to rituximab treatment. For each JOD1 spent on Rixathon, an additional JOD3.21 must be spent on Mabthera, an additional JOD0.55 on Tromax, and an additional JOD0.53 on Truxima. Rituximab biosimilars were associated with cost savings in all approved indications in Jordan compared to reference rituximab. Rixathon was associated with the lowest annual cost, the highest percentage of expanded patient access for all six indications, and the lowest NNC providing 10 additional patients with access.

Additional file 1 Table S1. Definitions of the outcomes for included studies. Fig. S1. Quality assessment of included randomized controlled trials. Fig. S2. Funnel plot for the VTE events outcome in the thromboprophylaxis studies. Fig. S3. Funnel plot for the symptomatic VTE events outcome in the thromboprophylaxis studies. Fig. S4. Funnel plot for the major bleeding events outcome in the thromboprophylaxis studies. Fig. S5. Funnel plot for the clinically relevant nonmajor bleeding events outcome in the thromboprophylaxis studies. Fig. S6. Funnel plot for the major or clinically relevant nonmajor bleeding events outcome in the thromboprophylaxis studies. Fig. S7. Funnel plot for the VTE recurrence outcome in the treatment studies. Fig. S8. Funnel plot for the major bleeding events outcome in the treatment studies. Fig. S9. Funnel plot for the clinically relevant nonmajor bleeding events outcome in the treatment studies. Fig. S10. Funnel plot for the major or clinically relevant nonmajor bleeding events outcome in the treatment studies. Fig. S11. Thromboprophylaxis results (DOACs vs. LMWH). Fig. S12. Thromboprophylaxis results (DOACs vs. placebo).