OA17.01 Estimate of Economic Impact of Immune Checkpoint Inhibitors for NSCLC Relative to PD-L1 Expression in the US

Abstract

Delivering high-quality cancer care at an affordable cost is the main challenge for health care professionals and policy makers. Immunotherapy achieved encouraging results in NSCLC. PD-L1 expression is being studied as a predictive biomarker. The objective of our study is to assess the economic impact of NIVO and PEMBRO with and without the use of PD-L1 as a biomarker in the US. We developed a decision-analytic model to determine the cost-effectiveness of PD-L1 assessment and second-line treatment with NIVO or PEMBRO versus docetaxel. The model used outcomes data from RCTs and costs from the US. We included the costs of adverse events and post-progression therapies. Thereafter, we used American epidemiology data to estimate the impact of the treatment. We included three RCTs (two with NIVO and one with PEMBRO). The estimated number of cases eligible was 37,638. Treating all patients with NIVOLUMAB would cost 1.6 billion dollars each year, increasing total oncology drug expenditure in the US by 4%. Treating only patients with PD-L1 > 1% with NIVOLUMAB would cost US$ 850 million each year and would increase total oncology drug expenditure by 2%. However, with such patient selection up to 46% of cases would not be treated and 2,509 fewer life-years would be saved. The cost of each year-of-life saved was improved by PD-L1 selection (from US$ 223,000 to US$ 186,000 thousand). Table 1 summarizes our findings. Results were similar with NIVOLUMAB and PEMBROLIZUMAB.Tabled 1ScenarioQALY gainICER U$Life-Years SavedYears of life not savedNot Treated%Total Cost U$Impact on Total Cancer Drug ExpenditureCost/LYS U$37,638100NIVO ALL COMERS0.148124K7,0430001.6 bi4%223KNIVO PD-L1 > 1%0.20191K4,5342,50917,38946850 mi2%186KPEMBRO PD-L1 > 1%0.138116K5,302NA12,68534971 mi2%183KNIVO ALL SQ/>1% NSQ0.21693K5,8681,17513,303351 bi3%178KPEMBRO PD-L1 > 50%0.16497K2,270NA26,91272420 mi1%184K Open table in a new tab The use of PD-L1 expression as a biomarker for treatment with immunotherapy 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 warranted in order to find the optimal strategy for patient selection.