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B. Gutierres

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    OA17 - Aspects of Health Policies and Public Health (ID 397)

    • Event: WCLC 2016
    • Type: Oral Session
    • Track: Regional Aspects/Health Policy/Public Health
    • Presentations: 1
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      OA17.01 - Estimate of Economic Impact of Immune Checkpoint Inhibitors for NSCLC Relative to PD-L1 Expression in the US (ID 4133)

      16:00 - 17:30  |  Author(s): B. Gutierres

      • Abstract
      • Presentation
      • Slides

      Delivering high-quality cancer care at an affordable cost is the main challenge for health care professionals and policy makers. Immunotherapy achieved encouraging results in NSCLC. PD-L1 expression is being studied as a predictive biomarker. The objective of our study is to assess the economical impact of NIVO and PEMBRO with and without the use of PD-L1 as a biomarker in the US.

      We developed a decision-analytic model to determine the cost-effectiveness of PD-L1 assessment and second-line treatment with NIVO or PEMBRO versus docetaxel. The model used outcomes data from RCTs and costs from the US. We included the costs of adverse events and post-progression therapies. Thereafter, we used American epidemiology data to estimate the impact of the treatment.

      We included three RCTs (two with NIVO and one with PEMBRO). The estimated number of cases eligible was 37,638. Treating all patients with NIVOLUMAB would cost 1.6 billion dollars each year, increasing total oncology drug expenditure in the US by 4%. Treating only patients with PD-L1 > 1% with NIVOLUMAB would cost US$ 850 million each year and would increase total oncology drug expenditure by 2%. However, with such patient selection up to 46% of cases would not be treated and 2,509 fewer life-years would be saved. The cost of each year-of-life saved was improved by PD-L1 selection (from US$ 223,000 to US$ 186,000 thousand). Table 1 summarizes our findings. Results were similar with NIVOLUMAB and PEMBROLIZUMAB.

      Scenario QALY gain ICER U$ Life-Years Saved Years of life not saved Not Treated % Total Cost U$ Impact on Total Cancer Drug Expenditure Cost/LYS U$
      37,638 100
      NIVO ALL COMERS 0.148 124K 7,043 0 0 0 1.6 bi 4% 223K
      NIVO PD-L1 > 1% 0.201 91K 4,534 2,509 17,389 46 850 mi 2% 186K
      PEMBRO PD-L1 > 1% 0.138 116K 5,302 NA 12,685 34 971 mi 2% 183K
      NIVO ALL SQ/>1% NSQ 0.216 93K 5,868 1,175 13,303 35 1 bi 3% 178K
      PEMBRO PD-L1 > 50% 0.164 97K 2,270 NA 26,912 72 420 mi 1% 184K

      The use of PD-L1 expression as a biomarker for treatment with immunotherapy decreases the overall economic impact and the cost per life-year saved. Nevertheless, the number of life-years saved with this strategy would be significantly smaller than if we choose to treat all patients. Further study and societal discussion is warranted in order to find the optimal strategy for patient selection.

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