Virtual Library
Start Your Search
Jaime Gonzalez Diaz
Author of
-
+
P1.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 947)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
-
+
P1.15-26 - A Review of Colombian National Administrative Cancer Registry (NACR) Data to Evaluate Healthcare Delivery and Biologics Use (ID 14354)
16:45 - 18:00 | Author(s): Jaime Gonzalez Diaz
- Abstract
Background
The Office of High Cost of the Colombian Health Ministry created the National Administrative Cancer Registry (NACR) data first in 2015 to provide comprehensive cancer data to improve cancer outcomes while serving as a model for other resource-limited countries. Despite new targeted therapies throughout the world, the benefits of these therapies have not reciprocated in lower resource settings, notably in Latin America. The purpose of this study is to investigate aspects of the NACR data that underscore some of the health care limitations of lung cancer treatment in Colombia.
a9ded1e5ce5d75814730bb4caaf49419 Method
We obtained National Administrative Cancer Registry (NACR) data from the High-Cost Diseases Office (Cuenta de Alto Costo [CAC]) collected in 2015 and released in 2016. All cancer cases diagnosed in the country are reported by payers and providers otherwise there are no payments for services rendered, assuring that the registry is representative. We use descriptive statistics for presentation of data and comparisons.
4c3880bb027f159e801041b1021e88e8 Result
A total of 3,082 patients were analyzed of which 2,043 (66.29%) had contributive insurance, 820 (26.60%) had subsidized insurance, and 98 (3.18%) had special or exempt insurance. Four patients (0.12%) had no insurance. Of newly diagnosed patients, the median number of days from suspicion to diagnosis was 27 days (IQR = 12-45 days, n = 491) with the predominant range of patients with contributive insurance being 30-59 days, and for subsidized insurance being 15-29 days. The median number of days from diagnosis to first treatment was 31 days (IQR=14-62, n=346) with the predominant range for patients with both contributive and subsidized insurance being 30-59 days. There was a greater percentage of Stage IV cancers in patients with subsidized (34%) than contributive (23%) insurance. Of those receiving chemotherapy (n=275), 52% received carboplatin, 28.3% received pemetrexed, 27.6% received cisplatin, 25.4% received paclitaxel, 10.9% received bevacizumab, and 5.1% received erlotinib; no patients received nivolumab or pembrolizumab.
8eea62084ca7e541d918e823422bd82e Conclusion
Based on findings from NACR, the wait time from suspicion to treatment took nearly two months underscoring the need for better streamline of lung cancer care. Also, data shows a low percentage of use of newer therapies, including EGFR-targeted agents despite a high prevalence of mutations, which are present in around a quarter of patients in Colombia (Raez, 2017). Colombia can strongly benefit from increased access to molecular testing and biologics given the future direction of lung cancer therapy.
6f8b794f3246b0c1e1780bb4d4d5dc53
-
+
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
-
+
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): Jaime Gonzalez Diaz
- 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
