CP2 ESTIMATING THE SURVIVAL AND COST IMPACT OF INTRODUCING FIRST-LINE ALECTINIB AND OSIMERTINIB FOR PATIENTS WITH ADVANCED NSCLC: AN ITEN MODEL ASSESSMENT

Abstract

The impact of treatment evolution in non-small cell lung cancer (iTEN) model is a discrete event simulation of advanced NSCLC (aNSCLC) patient treatment plans, developed to predict the survival and cost of treating aNSCLC. Model development and validation have been presented (Moldaver et al., 2018a, b. J Thorac Oncol). The objective of this analysis was to estimate the survival and cost impact of introducing first-line osimertinib and alectinib. A modified Delphi process with Canadian clinical experts established current practice patterns (without first-line alectinib and osimertinib) and future practice patterns with first-line alectinib and osimertinib for ALK and EGFR positive aNSCLC, respectively. Scenario analyses estimated the impact of increased targeted therapy and immunotherapy use in subsequent treatment. The efficacy of first-line alectinib and osimertinib were estimated from Kaplan–Meier (KM) progression free and overall survival data, as previously described. Simulated patient performance status (PS) ranged between 0-4 and affected treatment decisions; population characteristics were derived from Canadian literature. Included costs (2018 CDN $) were: drug acquisition and the costs of administration monitoring, imaging, physician visits, end-of-life, best supportive care and adverse event management. First-line alectinib for ALK patients was estimated to increase 5-year survival from 12% to 29.2% and the cost of treatment from $243,721 to $353,108. Second-line targeted therapy or increased use of immunotherapies further increased 5-year survival to 34% and costs to between $406,023 - $410,697. First-line osimertinib for EGFR patients was estimated to increase 5-year survival from 2% to 11.6%, and per-patient costs from $89,909 to $260,255. Subsequent treatment with immunotherapies remains inconclusive in EGFR aNSCLC and had limited impact on results. Modeling healthier populations (ie, PS 0-1) increased all 5-year survival estimates. First-line osimertinib and alectinib may increase the survival and average per-patient treatment costs of Canadian EGFR and ALK aNSCLC patients.