OBJECTIVES: Malignant pleural mesothelioma (MPM) treatments are available, but for many people with this type of rare cancer, a cure isn't possible. Quantifying the potential budget impact of these new treatments is of interest to health care decision-makers. Our aim was to estimate the budget impact of nivolumab plus ipilimumab for the management of patients with MPM in the United States over a time horizon of 5 years.

METHODS: An Excel-based model was developed to estimate the budget impact for a U.S. health plan from a payer perspective by introducing the combination of nivolumab plus ipilimumab, which represents the newest treatment for MPM. The comparators were nivolumab and pembrolizumab and our analysis included treatment and administration costs for the management of MPM. Dosing, duration of therapy, and adverse event rates were based on clinical trials and literature searches. The treatment and administration costs were calculated using the RED BOOK and CMS Services fee schedules. Market shares were estimated for each comparator before and after the new treatment's adoption.

RESULTS: In a hypothetical scenario of 100 incidence cases in 2023 with 0%–1% annual growth, it was estimated that there would be approximately 100 eligible incident MPM patients in 2023, increasing to 102 eligible incident patients in 2027. With an assumed market share of approximately 20% for nivolumab plus ipilimumab in 2023, the net budget impact would be $821,507. With a 50% market share in 2027, the budget impact would be $2,705,011.

CONCLUSIONS: Treatment of MPM patients with nivolumab plus ipilimumab has a budget impact with a cumulative increase in cost of $9,257,242 over a time horizon of 5 years. This increase in cost is due to the higher PFS value for the nivolumab plus ipilimumab combination (7 months) compared to only 3 months for both of the comparators.