Costs of Target Therapy and Proportionality to Number of Purchases: Propose Using Maintenance Dose and Limited Duration

Abstract

The 2-year costs of the immune check point inhibitors (ICI) were equitable with overall survival in advanced/metastatic non-small lung cancer. Target therapy (TT) is presently continued till disease progression or toxicity. The TT 2-3-year costs were justified in view of outcome and safety. Economically, what matters most is duration of use beyond 3-years. Li et al (2022)) identified the cost burden of prolonged TT administration. Guirgis (2023) suggested using caps to limit costs. The current cost policy of continued TT is untenable, and a fresh perspective is warranted. Objectives: 1-Focus on the deleterious cost impact of prolonged TT. 2-Propose using maintenance doses at 50% of the current recommendations and 4-year-limit. Methods: The ICI costs were calculated as dose in mg x price x number of cycles and TT as the monthly optimal dose x 12. Results: The 2019 Pembrolizumab, ICI prototype, was at $134,796 cost in 2018-19, increasing to $190,400 in 2023. The median cost of 5-ICI was $163,640. The 3-month $47,700 cost, if therapy extended beyond 2-years, was unnecessary due lack of further survival. The annual Osimertinib cost, TT prototype, was $229,600, the median of 5-TT. Costs multiplied with each extended year. We reasoned that if 3000 United States patients be treated by all TT at $229,600 for 5-years, the cost would mount to $344,000,000. If used for 4-years, the cost would drop to $2,755,200,000. Treating 9000 patients in the European nations for 5-years would cost $10,332,000,000 and 4-years $8,265,600,000. Using TT dose as maintenance at 50% of the current recommendations would further cut costs. Conclusion: Costs of TT were proportional to number of purchases. The proposed TT maintenance dose and the 4-year-limit on duration of use in advanced lung cancer would drastically cut costs. Clinical studies are warranted to ensure the safety of our proposal.