Sequential targeted therapy in advanced metastatic and recurrent cervical cancer: Cost analysis of the patient journey (323)

Abstract

Objectives: To evaluate the clinical outcomes and cost-effectiveness of novel therapy sequencing in the treatment of metastatic and recurrent cervical cancer. Methods: Models were simulated based on three potential treatment sequences: 1) doublet first-line chemotherapy+bevacizumab (chemo-bev) from the GOG-240 study, then second-line cemipli- mab (cemi) from the GOG-3016 trial (chemo+bev→cemi), 2) doublet chemo+bev+pembrolizumab (chemo+bev+pemb) from KEYNOTE- 826, then second-line single-agent chemo based on GOG 3016 (chemo+bev+pemb→chemo) and 3) doublet chemo+bev+pemb then second-line tisotumab vedotin (tiso) from GOG 3023 (chemo+bev+pemb→tiso). These were compared to a reference of chemotherapy only, with doublet first line (chemo) from the GOG 240 study followed by single-agent chemotherapy (chemo) based on the GOG 3016 study (chemo→chemo). Results: Based on IBM Micromedex RED BOOK™ and company listed costs, bevacizumab was estimated to cost $8,700 per cycle, cemi- plimab $13,181 per cycle, pembrolizumab $10,067 per cycle, and tisotumab vedotin estimated at $34,000 per month. For the reference sequence therapeutics, doublet chemo was estimated to cost $1,126 per cycle, and single-agent chemo was estimated at $1,944 per cycle. The total cost for each sequence was calculated based on the median cycles of each therapeutic. Each regimen sequence with the total cost and associated median overall survivals are listed in Table 1. The incremental cost-effectiveness ratio (ICER) and willingness to pay analyses are currently pending approval by the FDA, along with definitive costs of drugs. Conclusions: Our data suggest that the combination of immunotherapies and biologics has substantially increased overall survival. Early introduction of targeted therapy is not only associated with prolonged survival but also increased cost. Since treatment cost is primarily related to the cost of medicines, decreasing the price of these agents will make palliative treatments more cost-effective. Objectives: To evaluate the clinical outcomes and cost-effectiveness of novel therapy sequencing in the treatment of metastatic and recurrent cervical cancer. Methods: Models were simulated based on three potential treatment sequences: 1) doublet first-line chemotherapy+bevacizumab (chemo-bev) from the GOG-240 study, then second-line cemipli- mab (cemi) from the GOG-3016 trial (chemo+bev→cemi), 2) doublet chemo+bev+pembrolizumab (chemo+bev+pemb) from KEYNOTE- 826, then second-line single-agent chemo based on GOG 3016 (chemo+bev+pemb→chemo) and 3) doublet chemo+bev+pemb then second-line tisotumab vedotin (tiso) from GOG 3023 (chemo+bev+pemb→tiso). These were compared to a reference of chemotherapy only, with doublet first line (chemo) from the GOG 240 study followed by single-agent chemotherapy (chemo) based on the GOG 3016 study (chemo→chemo). Results: Based on IBM Micromedex RED BOOK™ and company listed costs, bevacizumab was estimated to cost $8,700 per cycle, cemi- plimab $13,181 per cycle, pembrolizumab $10,067 per cycle, and tisotumab vedotin estimated at $34,000 per month. For the reference sequence therapeutics, doublet chemo was estimated to cost $1,126 per cycle, and single-agent chemo was estimated at $1,944 per cycle. The total cost for each sequence was calculated based on the median cycles of each therapeutic. Each regimen sequence with the total cost and associated median overall survivals are listed in Table 1. The incremental cost-effectiveness ratio (ICER) and willingness to pay analyses are currently pending approval by the FDA, along with definitive costs of drugs. Conclusions: Our data suggest that the combination of immunotherapies and biologics has substantially increased overall survival. Early introduction of targeted therapy is not only associated with prolonged survival but also increased cost. Since treatment cost is primarily related to the cost of medicines, decreasing the price of these agents will make palliative treatments more cost-effective.