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Erik Orava



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    EX04 - Mini Oral Abstract Session - MA08.06, MA18.02, MA19.02, MA20.11 (ID 1006)

    • Event: WCLC 2018
    • Type: Exhibit Showcase
    • Track: Advanced NSCLC
    • Presentations: 1
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      EX04.02 - The Impact of Treatment Evolution in NSCLC (iTEN) Model: Development and Validation (ID 13468)

      10:00 - 10:05  |  Author(s): Erik Orava

      • Abstract
      • Slides

      Background

      Background: The iTEN model was developed to estimate the survival impact of new treatments for advanced NSCLC (aNSCLC) patients. The structure and key assumptions of the iTEN model and outputs validated against published real-world survival data are presented.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Methods: The iTEN model is a discrete event simulation of aNSCLC patients’ treatment plans. Individual patient characteristics (histology, molecular subtypes (EGFR, ALK, ROS1, BRAF, PD-L1), and performance status) are generated by random sampling from Canadian prevalence estimates. All Health Canada approved agents for treatment of aNSCLC are included. Simulated patients start on first-line therapy and move to subsequent lines of therapy in modelled progression events. Up to six-lines of therapy can be included. Time-of-event for progression or death for each patient is calculated based on random probabilities and progression-free survival (PFS) and overall survival (OS) curves modelled from published clinical trials. For example, a simulated ALK+ patient might receive first-line crizotinib, followed by second-line ceritinib and BSC, based on PFS/OS data from PROFILE 1014 and ASCEND-5. Predicted OS is calculated as the cumulative time spent on active therapy and BSC. PFS/OS data were extrapolated using best practices. Treatment on previous therapies was assumed to have no impact on the efficacy of subsequent therapies. Model survival predictions were validated against published real-world estimates from the Ontario Cancer and Austrian (TYROL) registries, by reproducing the same treatment mix in the simulated patients as in the publications.

      4c3880bb027f159e801041b1021e88e8 Result

      Results: iTEN estimated two- to five-year survival rates were similar to those reported by the Ontario Cancer and TYROL registries.

      abstract1 image.png

      8eea62084ca7e541d918e823422bd82e Conclusion

      Conclusions: While further analyses are required, the iTEN model produces survival estimates comparable to published real-world data; therefore, the iTEN model may be a valid tool to estimate aNSCLC patient survival.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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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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      P2.15-09 - The Impact of Treatment Evolution in NSCLC (iTEN) Model: Survival and Cost of Treating Patients with Advanced NSCLC in 2017 (ID 13477)

      16:45 - 18:00  |  Author(s): Erik Orava

      • Abstract
      • Slides

      Background

      Background: The life expectancy and healthcare costs of treating advanced NSCLC (aNSCLC) patients are expected to rise as new targeted and immuno-oncology (IO) therapies are approved for clinical practice. Here, we have used the iTEN model to estimate the cost of managing aNSCLC patients in Canada in 2017.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Methods: The iTEN model development and validation are presented in an accompanying abstract (“The iTEN model: Development and Validation”). A treatment algorithm for EGFRm, T790m, ALK re-arrangement and PD-L1+ aNSCLC patients in 2017 was generated through a modified Delphi process based on anonymous responses from Canadian clinical experts. The generated treatment algorithm was used to estimate the survival and life-time costs of managing patients. Health resource use and cost estimates included drug acquisition and administration, adverse events, laboratory and radiologic monitoring, physician visits and end of life costs (2018 costs). Cost estimates were based on published literature, Ontario formulary listings, Cancer Care Ontario recommendations and the Ontario Case Costing Initiative. The estimation of survival is described in the companion abstract.

      4c3880bb027f159e801041b1021e88e8 Result

      Results: Survey responses indicated that first-line therapy is consistent with current guideline recommended practice, but that care beyond the second-line is variable, particularly with respect to IO usage. Modelled life expectancy varied based on the molecular subtype of aNSCLC. Costs over the span of an average aNSCLC patient’s life-time were estimated to be $89,899 (range: $61,134-$194,158). In comparison, the life-time cost of treating a Canadian lung cancer patient in 2007 (ie, prior to the introduction of IOs and ALK TKIs), inflated to 2018 dollars, was an estimated $60,678 (de Oliveira et al., 2016).

      abstract2 image - corrected.png

      8eea62084ca7e541d918e823422bd82e Conclusion

      Conclusions: Results suggest that aNSCLC patient survival increases in conjunction with increased expenditure. The iTEN model may be used to assess the impacts of evolving treatment paradigms in aNSCLC.

      6f8b794f3246b0c1e1780bb4d4d5dc53

      Only Active 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 or select "Add to Cart" and proceed to checkout.