Delivering high quality cancer care at an affordable cost is one of the main challenges for health care professionals and policy makers, especially in lowand middle-income countries. 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.info:eu-repo/semantics/publishedVersio

Aguiar, Pedro, Jr.

Babiker, Hani

De Mello, Ramon Andrade

Lopes, Gilberto

Tadokoro, Hakaru

Journal of Thoracic Oncology

English

Universidade do Algarve

An estimate of the economic impact of immunotherapy relative to PD-L1 expression in Brazil - An update with brazilian costs

Pedro Aguiar

Ramon De Mello

Hakaru Tadokoro

Hani Babiker

Gilberto Lopes

Crossref

MA14.11 An Estimate of the Economic Impact of Immunotherapy Relative to PD-L1 Expression in Brazil - An Update with Brazilian Costs

Aguiar, Pedro

De Mello, Ramon

Tadokoro, Hakaru

Babiker, Hani

Lopes, Gilberto

University of Miami: Scholarship Miami

Sapientia

January 2017 Abstracts S427administration and adverse event management costswere included in the model. The base-case analysis useda time horizon of 20 years. Costs and health outcomeswere discounted at a rate of 3% per year.Results: Base case results project for PD-L1 positive(TPS>¼50%) patients treated with pembrolizumab amean survival of 2.25 years. For docetaxel, a mean sur-vival time of 1.07 years was estimated. Weekly diseasemanagement costs observed in KN010 for the progres-sion-free state were $866 and $1,298 for pembrolizumaband docetaxel, respectively. Weekly disease managementcosts for the progressive disease state were $1,938 basedon a US healthcare claim database. Results projected totaldiseasemanagement costs to be $166Kper patient treatedwith pembrolizumab compared with $93K for docetaxelbecause of extended progression-free and post-progres-sion survival with pembrolizumab. Nearly half (45%) oftotal expected cost differences between pembrolizumaband docetaxel are due to the incremental disease man-agement costs. Further analyses that exclude drug treat-ment costs show that the additional disease managementcosts associated with extended progression-free andoverall survival exceed $50,000 per LY gained ($61,864).Conclusion: Pembrolizumab improves outcomescompared to docetaxel in PD-L1 positive (TPS>¼50%)pre-treated advanced NSCLC patients in the US. Theimproved overall survival with pembrolizumab isaccompanied by the economic reality of additional non-pembrolizumab costs that represent their own substan-tial economic burden.Keywords: Cost-effectiveness, PD-L1, advance NSCLCMA14.11An Estimate of the Economic Impact ofImmunotherapy Relative to PD-L1Expression in Brazil - An Update withBrazilian CostsPedro Aguiar Jr.,1 Ramon De Mello,2Hakaru Tadokoro,1 Hani Babiker,3 Gilberto Lopes41Universidade Federal de São Paulo, São Paulo/Brazil,2Universidade Do Algarve, Faro/Portugal, 3Honor Health,SCENARIOQALYGAINICER(US$)LIFE-YEARSSAVEDYEARS OFNOT SAVEDNIVO ALL COMERS 0.148 129 K 885 0NIVO PD-L1 > 1% 0.201 108 K 570 315PEMBRO PD-L1 > 1% 0.138 137 K 666 NANIVO ALL SQ/ > 1% NSQ 0.216 99 K 738 147PEMBRO PD-L1 > 50% 0.164 116 K 285 NAScottsdale/AZ/United States of America, 4HCOR CancerCenter, São Paulo/BrazilBackground: Delivering high quality cancer care at anaffordable cost is one of the main challenges for healthcare professionals and policy makers, especially in low-and middle-income countries. The objective of our studyis to assess the economic impact of nivolumab andpembrolizumab with and without the use of PD-L1 as abiomarker in Brazil.Methods: We developed a decision-analytic model todetermine the cost-effectiveness of PD-L1 assessmentand the second-line treatment with NIVO or PEMBROversus docetaxel. The model used outcomes data fromrandomized clinical trials and drug acquisition costswere estimated using current prices in Brazil. Thereafter,we used Brazilian epidemiologic data to estimate theeconomic impact.Results: We included three RCTs (two with NIVO andone with PEMBRO). The estimated number of caseseligible for therapy with immune checkpoint inhibitors is4,733. Treating all patients with NIVOLUMAB would costUS$ 173 million dollars each year, representing an in-crease of 21% in current Brazilian expenses for cancerdrugs acquisition. Treating only patients with PD-L1 >1% with NIVOLUMAB would cost 93 million dollarsevery year, leading to an increase of 11.3% in expensesfor cancer drugs acquisition. However, with such selec-tion, up to 46% of cases would not be treated and 315years of life would be lost compared to treating all pa-tients regardless of PD-L1 expression. The cost of eachyear-of-life saved was improved by PD-L1 selection(from US$ 196,000 to US$ 164,000). Table 1 summarizesour findings for five different scenarios of treatment. Theresults were similar with NIVOLUMAB andPEMBROLIZUMAB.Conclusion: The use of PD-L1 expression as a biomarkerfor treatment with immune checkpoint inhibitors de-creases the overall economic impact and the cost perlife-year saved. Further study and societal discussion isneeded in order to find the optimal strategy for patientselection.Keywords: Pharmacoeconomy, Policy Maker, Immuno-therapy, biomarkerLIFE % NOTTREATEDTOTALCOST (US$)IMPACT ON TOTALCANCER DRUGEXPENDITURECOST/LYS(US$)0% 173 Million 21.1% 196 K46% 93 11.3% 164 K34% 100 12.1% 150 K35% 116 14.0% 157 K72% 43 5.2% 151 K

https://sapientia.ualg.pt/bitstream/10400.1/13305/1/1-s2.0-S1556086416317361-main.pdf

An estimate of the economic impact of immunotherapy relative to PD-L1 expression in Brazil - An update with brazilian costs

Abstract

Similar works

Full text

Available Versions

Universidade do Algarve

Crossref

University of Miami: Scholarship Miami

Sapientia