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Pedro Aguiar Jr
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OA04 - Improving Access and Outcomes in Lung Cancer Management (ID 898)
- Event: WCLC 2018
- Type: Oral Abstract Session
- Track: Nursing and Allied Professionals
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 10:30 - 12:00, Room 201 F
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OA04.01 - What is the Cost of a Strong Evidence for the Treatment of Advanced Non-Small Cell Lung Cancer? (ID 14410)
10:30 - 10:40 | Presenting Author(s): Pedro Aguiar Jr
- Abstract
- Presentation
Background
Evidence-based medicine was developed to guide medical decisions based upon the strongest scientific evidence available in the literature. However, large randomized clinical trials are expensive. In addition, new antineoplastic drugs development is also extremely expensive. Therefore, we hypothesized that the strongest evidence available nowadays comes from studies developed by the pharmaceutical industry.
a9ded1e5ce5d75814730bb4caaf49419 Method
We carried out a search on network databases for studies published between 2014 and 2017. We included only experimental studies that assessed the treatment for advanced or metastatic non-small cell lung cancer. All included studies were divided into two groups: studies funded by pharmaceutical industry and studies funded by other sources. The primary end point was to compare the evidence strength of each group. Secondary end points were to compare other aspects, such as the number of patients included by each group of studies and the number of innovative drugs studied by each group of studies.
4c3880bb027f159e801041b1021e88e8 Result
We found 1,502 studies and included 299 studies (154 sponsored by pharmaceutical industry and 145 funded by other sources). 52,988 patients were included in all studies (36,455 in studies sponsored by industry and 16,533 in studies with other funding sources; p < 0.001). The studies funded by pharmaceutical industry had the stronger evidence compared with studies with other sources of funding (p = 0.005). Moreover, studies sponsored by pharmaceutical industry studied more innovative therapies (72.4% versus 48.9%; p < 0.001) and had a higher proportion of open access manuscript (60.8% versus 43.9%; p = 0.004). Results are summarized in the table.
Parameter Industry Sponsored P value Yes
154 (100%)
No
145 (100%)Number of patients 36,455 16,533 <0.001 Mean N of patients 236.7 115.6 Line First 110 (71.4%) 94 (64.8%) 0.220 Second or more 44 (28.6%) 51 (35.2%) Biomarker Yes 55 (35.9%) 55 (37.9%) 0.723 No 98 (64.1%) 90 (62.1%) Innovative Tx Yes 110 (72.4%) 69 (48.9%) <0.001 No 42 (27.6%) 71 (51.1%) Phase I 20 (13%) 25 (17.2%) 0.409 II 101 (65.6%) 97 (66.9%) III 32 (20.8%) 21 (14.5%) IV 1 (0.6%) 2 (1.4%) Evidence Level 1 0 (0%) 1 (0.7%) 0.005 2 76 (49.4%) 52 (35.9%) 3 78 (50.6%) 87 (60%) 4 0 (0%) 5 (3.4%) Experimental Yes 35 (47.3%) 26 (50%) 0.765 Superiority No 39 (52.7%) 26 (50%) Open Access Yes 93 (60.8%) 61 (43.9%) 0.004 Article No 60 (39.2%) 78 (56.1%)
8eea62084ca7e541d918e823422bd82e Conclusion
Studies funded by pharmaceutical industry had stronger evidence, tested more innovative therapies, and were more accessible to the readers compared with studies developed with other sources of funding. These findings may alert oncology cooperative groups to the need of more studies with more evidence strength.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P2.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 964)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.15-18 - Cost-Effectiveness Analysis of Second-Line Immune Checkpoint Inhibitors for Advanced NSCLC in Colombia (ID 14109)
16:45 - 18:00 | Author(s): Pedro Aguiar Jr
- Abstract
Background
Immune checkpoint inhibitors improve outcomes compared with chemotherapy in lung cancer. Tumor PD-L1 receptor expression is being studied as a predictive biomarker. The greatest challenge in oncology today is how to reconcile improvements in the management of cancer with the exponentially increasing costs of new treatment and this is a very important barrier in low and middle income countries. The objective of this study was to assess the cost-effectiveness and economic impact of second-line treatment with nivolumab and pembrolizumab with and without the use of PD-L1 testing for patient selection in Colombia .
a9ded1e5ce5d75814730bb4caaf49419 Method
We designed a decision-analytic model to evaluate the cost-effectiveness of second-line immunotherapy versus docetaxel for advanced NSCLC. We considered the outcomes from randomized clinical trials (RCTs). Direct and indirect costs were retrieved with a colombian perspective. We followed standard recommendations for the conduct and reporting of health economic analyses. Primary endpoint were Incremental Cost Effectiveness Ratios (ICER), for treatment with nivolumab and pembrolizumab with and without PDL1 testing.
4c3880bb027f159e801041b1021e88e8 Result
Nivolumab improved quality-adjusted life-years (QALY) by 0.417 among squamous tumors and 0.287 among non squamous tumors. The ICER were $135,093 COP and $179,391 COP, respectively. Pembrolizumab achieved a QALY gain of 0.346 and the ICER was $146,022 COP. The use of PD-L1 expression as a tailor biomarker for nivolumab among non-squamous tumors improved incremental QALY by up to 157% and decreased the ICER by up to 61% compared with treating all patients. Considering a willingness to pay threshold of three times the Colombian Gross Domestic Product per capita, second-line immunotherapy was not cost-effective with or without patient selection by PD-L1 expression.
8eea62084ca7e541d918e823422bd82e Conclusion
Patient selection by PD-L1 expression increased cost-effectiveness of immunotherapy. Second-line immunotherapy was not cost-effective in Colombia due to its high cost. Taking into account the disparities in access to cancer innovative therapies, there is a need to promote strategies to reduce drug acquisition costs, such as price discrimination and the use of biosimilars or generics.
6f8b794f3246b0c1e1780bb4d4d5dc53
