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P2.45: An Estimate of the Economic Impact of Treatment of NSCLC With Immunotherapy Relative to PD-L1 Expression in Brazil

2016; Elsevier BV; Volume: 11; Issue: 10 Linguagem: Inglês

10.1016/j.jtho.2016.08.116

1556-1380

Pedro Nazareth Aguiar, Ramon Andrade de Mello, Hakaru Tadokoro, Bárbara de Souza Gutierres, Carmélia Maria Noia Barreto, Hani M. Babiker, Gilberto Lopes,

Economic and Financial Impacts of Cancer

Delivering high quality cancer care at an affordable cost is one of the main challenges for health care professionals and policy makers, especially in low- and middle-income countries. Imunne checkpoint inhibitors have achieved encouraging results in non-small cell lung cancer (NSCLC). Durable responses have been observed in approximately 20% of patients. Tumor PD-L1 receptor expression is being studied as a predictive biomarker. The objective of our study is to assess the economic impact of nivolumab and pembrolizumab with and without the use of PD-L1 as a biomarker in Brazil. We developed a decision-analytic model to determine the cost-effectiveness of PD-L1 assessment and the second-line treatment with NIVO or PEMBRO versus docetaxel. The model used outcomes data from randomized clinical trials and drug acquisition costs were estimated using current prices in the United States. We also included the costs of adverse events and post-progression therapies. Thereafter, we used Brazilian epidemiologic data to estimate the economic impact of the treatment with and without the use of PD-L1 as a biomarker. We included three RCTs (two with NIVO and one with PEMBRO). The estimated number of cases eligible for therapy with immune checkpoint inhibitors is 4,733. Treating all patients with NIVOLUMAB would cost US$ 198 million dollars each year, representing an increase of 24% in current Brazilian expenses for cancer drugs acquisition. Treating only patients with PD-L1 > 1% with NIVOLUMAB would cost 107 million dollars every year, leading to an increase of 12.9% in expenses for cancer drugs acquisition. However, with such selection, up to 46% of cases would not be treated and 315 years of life would be lost compared to treating all patients regardless of PD-L1 expression. The cost of each year-of-life saved was improved by PD-L1 selection (from US$ 223,000 to US$ 186,000). Table 1 summarizes our findings for five different scenarios of treatment. The results were similar with NIVOLUMAB and PEMBROLIZUMAB.Tabled 1ScenarioQALY gainICER U$Life-Years SavedYears of life not savedNot Treated%Total CostImpact on Total Cancer Drug ExpenditureCost/LYS U$4,733100NIVO ALL COMERS0.148124K885000198 mi24%223KNIVO PD-L1 >1%0.20191K5703152,18846107 mi13%186KPEMBRO PD-L1 >1%0.138116K666NA1,59634122 mi15%183KNIVO ALL SQ/>1% NSQ0.21693K7381471,67435132 mi16%178KPEMBRO PD-L1 > 50%0.16497K285NA3,3857253 mi6%184K Open table in a new tab The use of PD-L1 expression as a biomarker for treatment with immune checkpoint inhibitors decreases the overall economic impact and the cost per life-year saved. Nevertheless, the number of life-years saved with this strategy would be significantly smaller than if we choose to treat all patients. Further study and societal discussion is needed in order to find the optimal strategy for patient selection.