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Angel Herrera-Gomez
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OA11 - Decomplexifying Molecular Targets, Immunotherapy and Treatment Settings in the Real World (ID 137)
- Event: WCLC 2019
- Type: Oral Session
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
- Moderators:Kumar Prabhash, Jyoti D Patel
- Coordinates: 9/09/2019, 14:00 - 15:30, Interlaken (1988)
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OA11.05 - Optimizing Resources with Immunotherapy in Developing Countries: Experience in a Reference Center in Mexico (Now Available) (ID 2867)
14:00 - 15:30 | Author(s): Angel Herrera-Gomez
- Abstract
- Presentation
Background
Immunotherapy has proven clinical benefit in several tumors as a first line therapy or after standard treatment failure. Pivotal trials with immunotherapy were designed using a weight-based dose. However, recently as part of an effort to standardize the dose of the most common drugs (Nivolumab and Pembrolizumab) the Regulatory Agencies and Pharmaceutics have changed its prescription to fixed doses. In those pivotal studies, the median weight was around 70 to 80 kg. Our hypothesis estimates that a fixed dose increases the use of drug above effective thresholds increasing unnecessary expenses.
Method
We analyzed a cohort of patients treated with immunotherapy due to lung cancer (NSCLC) diagnosis either during first or second-line of treatment between 2016 and 2018 in the Thoracic Tumors Clinic at National Cancerology Institute in Mexico. We analyzed and estimated the median body in our population. Then, we compared treatment costs between weight-based doses (Nivolumab 3mg/Kg q.2 weeks and Pembrolizumab 2mg/Kg q.3 weeks) versus flat dose treatment (Nivolumab 240mg q.2 weeks and Pembrolizumab 200mg q.3 weeks).
Result
792 patients were included with and a median weight of 65 kg (SD ±13.11) was determined. Fixed dose of pembrolizumab administered during one year (17 applications) had an annual cost of $135,218 dlls. while the cost with weight-based dose was $87,913 dlls. with a net difference of $47,305 dlls. In the case of Nivolumab, an annual fixed-dose treatment (26 applications) has a cost of $114,816 dlls, while the weight-based dose has a cost of $93,392 dlls. with a net difference of $21,424 dlls (table1).
ConclusionPEMBROLIZUMAB (2 mg/Kg) Q3W vs 200mg Q3W
Comparison
Total dose per cycle
Cost per cycle
Excess cost per cycle
Dose difference
Annual cost treatment (17 cycles)
Net difference annual cost per patient
Weight based dose
(Median 65Kg)
130 mg
$5171.4
$2,782.6
70mg
$87,913
$47,305
Fixed-dose
200mg
$7,954
NA
NA
$135,218
NA
NIVOLUMAB (3mg/Kg) Q2W vs 240mg Q2W
Comparison
Total dose per cycle
Cost per cycle
Excess cost per cycle
Dose difference
Annual cost treatment (26 cycles)
Weight based dose
(Median 65Kg)
195mg
$3,592
$824
45mg
$93,392
$21,424
Fixed-dose
240mg
$4,416
NA
NA
$114,816
NA
General population in developing countries like Mexico are experiencing serious difficulties to get access to immunotherapy due to lack of coverage through Public Health Care System based in costs. According with our study, optimization of resources with weight-base dose could allow us to increase the rate of treated patients. Then, according with our analysis, in the case of Pembrolizumab we calculated coverage of 154 treatments instead of 100 using same budget and favoring the use of weight-based dose. While, in the case of Nivolumab we could increase the number of patients treated from 100 to 126 using weight-based dose. Therefore, our results support that therapies like immunotherapy should be calculated based on body weight as an attempt to increase access and avoid unnecessary expenses in Health Care Systems with limited resources.
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