Productivity losses under various second-line recurrent or metastatic cervical cancer treatment scenarios in the United States.

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e17520 Background: Recent data showed that a substantial proportion of second-line (2L)-eligible recurrent or metastatic cervical cancer (r/mCC) patients do not receive therapy. Additionally, although higher direct medical costs has been demonstrated with increasing r/mCC disease severity, there is no data on the impact of 2L treatment choices on societal costs. This study aims to estimate productivity loss due to untreated r/mCC and reduction in productivity losses associated with various 2L therapy options in the United States. Methods: We simulated the natural history of r/mCC by developing a Markov model with three stages: progression-free (PF), progressive (P), and death (D) for the course of r/mCC patients (average age: 50 years) during 2L treatment. We considered four treatment scenarios for patients who progressed on 1L systemic therapy: no 2L therapy, chemotherapy, overall 2L treatments (including option of cytotoxic monotherapy, immunotherapy, or other combination therapies), and tisotumab vedotin (TV). The model was parameterized and calibrated to match the overall survival and progression-free survival reported in recent clinical studies. Productivity loss associated with each disease stage was estimated by time spent at each stage, activity performance rate, and annual market and non-market productivity. Model outcomes included cumulative time spent in each stage and per patient 1-year and 5-year productivity losses. Results: Within a 1-year period, patients spend an estimated 6.1 months in the P stage under the no 2L treatment scenario; 4.4 months in PF and 4.3 months in P under 2L chemotherapy; 4.4 months in PF and 4.8 months P under overall 2L treatments scenario; and 5.7 months in PF and 4.3 months in P under TV scenario. Per person 1-year productivity under no 2L therapy was between $11.7K-$16.8K. As compared with no 2L therapy, 1-year per-person productivity improved by $5K-$14.6K under chemotherapy, by $5.8K-$15.6K under overall 2L treatments, and by $7.3-$19.9K under TV. When extending to a 5-year horizon, the projected cumulative per patient productivity improvement relative to that of patients with no 2L therapy ranged by $9.2K-$20.7K under chemotherapy, by $12.9K-$25.3K under overall 2L treatments, and by $19K-$36.9K under TV. Conclusions: Societal costs of 2L r/mCC in terms of lost productivity is substantially less in patients receiving 2L treatment vs. no treatment, within a 1-year period of becoming eligible for 2L therapy. Among patients receiving treatment (chemotherapy only or overall 2L treatment), we projected that society still incurs potentially meaningful lost productivity, relative to being treated with TV. TV’s 2021 approval in 2L r/mCC offers additional treatment option for patients, and continued efforts should be directed toward providing more treatment options in this setting.