Progression free survival (PFS) benefits of immuno-oncology agents (IOs) and implications for market cost-sharing inefficiencies.

Abstract

6643 Background: Cancer care expense has high financial toxicity with 6 in 10 patients reporting distress about finances. System wide cost has also increased with new treatment approvals; from 2011 to 2016 FDA approved 52 cancer treatments. During this time, US healthcare spending increased from $26.8 billion to $42.1 billion. Lung cancer has high mortality- in 2018 American Cancer Society estimated 234,030 new cases with 50% likely to die from the disease. Hence new treatments are important societal need but costs are concerning. Methods: We selected Phase 3 trials of IO based regimens for non-small cell lung cancer (NSCLC) in first line setting, approved by FDA in 2018. Median PFS was compared between intervention and no-intervention group (NIG). Total costs were evaluated using 2018 Medicare reimbursements rates. Cost and PFS were converted to represent expenditures accrued for 12 months (mths) PFS gain. Results: Study 1 (NCT02125461) for stage 3 NSCLC; looked at maintenance Durvalumab after platinum doublet chemoradiation induction. Median PFS 17.2 vs 5.6 mths in NIG. 1 year PFS cost $155,391 vs $27,477. Study 2 (NCT02578680) for stage 4 NSCLC; looked at maintenance Pembrolizumab, Pemetrexed or Pemetrexed alone after platinum doublet induction. Median PFS 8.8 vs 4.9 mths in NIG. 1 year PFS cost $283,949 vs $116,159. Study 3 (NCT02775435) for stage 4 NSCLC (squamous); looked at maintenance Pembrolizumab after platinum doublet induction. Median PFS 6.4 vs 4.8 mths in NIG. 1 year PFS cost $195,820 vs $119,146. Study 4 (NCT02366143) for stage 4 NSCLC; looked at maintenance Atezolizumab, Bevacizumab or Bevacizumab alone after platinum doublet induction. Median PFS 8.3 vs 6.8 mths in NIG. 1 year PFS cost $316,499 vs $199,278. Conclusions: Median PFS doubled from IOs in NSCLC but costs accrued, more than doubled. The expense has to be quantified in relation to per capita GNP in US- $53,128 in 2017. Accepting even a higher threshold of $100,000 for 1 quality adjusted life year gained, costs appear economically unsustainable. But PFS gains are significant indicating need to enable IOs utilization, by making innovative cost sharing platforms.