PCN114 ASSESSMENT OF THE SURVIVAL BENEFIT AND COST IMPACT OF NEW TREATMENTS FOR KEY ANSCLC BIOMARKERS USING THE ITEN MODEL

Abstract

Five novel therapies (osimertinib, alectinib, brigatinib, dabrafenib and trametinib and pembrolizumab combination therapy) are expected to rewrite routine clinical management of advanced non-small cell lung cancer (aNSCLC) in Canada. These new front-line treatment options will alter treatment sequencing in later lines, but the impact of this is unknown. The impact of Treatment Evolution in NSCLC (iTEN) model is a validated discrete event patient simulation designed to estimate the impact of treatment sequencing in aNSCLC. The objective of this analysis was to estimate the survival and cost impact of these five novel therapies in Canada. A treatment algorithm to reflect ‘current’ treatment in 2018 was developed with Canadian clinical experts via a modified Delphi process. This algorithm was updated with expert input to identify likely treatment sequencing after first-line osimertinib for EGFR patients, first-line alectinib followed by brigatinib for ALK patients, first-line dabrafenib plus trametinib for BRAF patients and pembrolizumab plus chemotherapy for driver-mutation negative patients expressing PD-L1 below 50%. Clinical efficacy of treatments was estimated from Kaplan–Meier progression-free and overall survival data, as previously described (Moldaver et al. 2018). Modelled costs (2018 CDN $) included drug acquisition and administration costs and the costs of ongoing monitoring, imaging, physician visits, end-of-life, best supportive care, and adverse event management. A treatment rate of 100% in the first line and 60% thereafter was modelled. Introduction of these five therapies was estimated to incrementally increase the average 1-year survival of EGFR, ALK, BRAF and PD-L1<50% patients by 12%, 9%, 22%, and 1% respectively. Three-year survival was estimated to increase by 20%, 28%, 10% and 4%, respectively. The average life-time cost per-treated-patient, regardless of biomarker positivity, increased from $159,764 to $269,056. New aNSCLC treatment options are expected to increase the survival and cost of managing aNSCLC patients in Canada.