Author of

• 25952

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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

  • 27240

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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  |  Presenting Author(s): Aylen Vanessa Ospina Serrano
    • Abstract
    • Slides

    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

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