Costs comparison of the immune check point inhibitors versus survival ratio in first-line non-small lung cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21050-e21050
Author(s):  
Helmy M. Guirgis
Keyword(s):  
Lung Cancer ◽  
Death Receptor ◽  
Survival Ratio ◽  
Check Point ◽  
First Line ◽  
Unresectable Stage ◽  
Programmed Death ◽  
Check Point Inhibitors ◽  
Death Receptor Ligand ◽  
One Year

e21050 Background: Five-year overall survival (OS) was reported in 20% of patients treated by Pembrolizumab (Pembro) in 1st-line advanced/metastatic (a/m)-non-small lung cancer (nsLC). Costs of the immune check point inhibitors (ICI) are relatively high and bound to increase with extended use. We purposed to weigh and compare costs of ICI vs outcome. Methods: OS, hazard ratio (HR) and survival ratio (SR) defined as (1.0-HR) were used. Chemo-drug excluded; costs were calculated in US$. Results: Adjuvant Durv one-year costs in unresectable stage III were $130,956, OS gain 363 days and SR 0.47. Pembro one-year costs were $134,778. OS were 474 and SR 0.37 in programmed death receptor-ligand-1 > 50%. At 5 years, costs were $673,890. Costs of 35-cycle Pembro combination were $336,945, OS 339 and SR 0.51. Costs increased with extended use. Atezolizumab/Bevacizumab-combination (Atezo/Bev) costs x 2-years were $492,114, OS 135 and SR 0.22. Using Biosimilar Bev costs dropped to $429,744. Ipilimumab/Nivolumab (Ipi/Nivo) costs x 2 were $544,696, OS 141 and SR 0.34. Costs of both Atezo/Bev and Ipi/Nivo increased by 50% with one year of extended use. Costs of Pembro-combination were 0.78 lower than Atezo/Bev and 0.62 than Ipi/Nivo. Pembro SR were 2.32 higher than Atezo/Bev and 1.65 than Ipi/Nivo. Absence of direct comparison, however, cast doubts on Pembro advantage. Conclusions: Costs of one-year adjuvant Durv, 3-year Pembro and 35-cycle Pembro-combination were considered fair and equitable with their corresponding SR. Pembro-combination costs were cheaper than Atezo/Bev and Nivo/Ipi. Costs of all drugs and combinations multiplied with extended use.

Costs of the immune check point inhibitors versus survival ratio in first-line non-small lung cancer, cost bundling proposal.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21034-e21034
Author(s):  
Helmy M. Guirgis
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Unmet Need ◽  
Survival Ratio ◽  
Check Point ◽  
First Line ◽  
Unresectable Stage ◽  
Check Point Inhibitors ◽  
One Year ◽  
Cancer Cost

e21034 Background: Pembrolizumab (Pembro) demonstrated marked prolongation of 5-year overall survival (OS) in 1st-line advanced/metastatic (a/m)-non-small lung cancer (nsLC). Adjuvant Durvalumab (Durv), Atezolizumab/Bevacizumab (Atezo/Bev), Ipilimumab/Nivolumab (Ipi/Nivo) and Pembro-combination have since improved the outcome. Progress, however, came at high costs of the immune check point inhibitors (ICI). There is unmet need for cost-constraining policies. We purposed 1- Weigh costs of ICI vs outcome 2- Propose cost bundling at negotiable $450,000 - $550,000 thresholds, depending on the number of companies and drugs involved. Methods: OS, hazard ratio (HR) and survival ratio (SR), defined as (1.0-HR) were used. Chemo-drugs excluded, costs of ICI doses were calculated in US$. Results: Durv one-year costs in unresectable stage III were $130,956, OS gain 363 days and SR 0.47. Pembro one-year costs were $134,778, OS 474 and SR 0.37 in PD-L1 > 50%. At 5 years, costs were $673,890. Bundling negotiated at $450,000-$550,000 would save $123,112-$223,890. Costs of 35 cycles of Pembro-combination were $336,945, OS 339 and SR 0.51. Costs of Atezo/Biosimilar-Bev-comnination supplied by > one company, were $429,744, OS 135 and SR 0.22. Ipi/Nivo costs were $544,696, OS 141 and SR 0.34. Costs of Atezo/Bev and Nivo/Ipi used beyond 2 years exceeded $550,000 and multiplied by one more of use. Costs of Pembro-combination were 0.78 lower than Atezo/Bev and 0.62 than Ipi/Nivo. Pembro SR were 2.32 higher than Atezo/Bev and 1.65 than Ipi/Nivo. Lack of direct comparison undermined Pembro SR advantage. Conclusions: Costs of one-year adjuvant Durv, 3-year Pembro and 35-cycle Pembro-combination seemed equitable with their corresponding SR and below the $450,000 threshold. Pembro-combination costs were cheaper than Atezo/Bev and Nivo/Ipi. ICI costs of extended use tend to support the bundling proposal.

Costs and hazard ratios of commonly used drugs in advanced/metastatic lung cancer at Cancer Free Foundation, Dana Point, California.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20508-e20508
Author(s):  
Helmy M. Guirgis
Keyword(s):  
Lung Cancer ◽  
Death Receptor ◽  
Metastatic Lung Cancer ◽  
Net Benefit ◽  
Cancer Society ◽  
Flat Dose ◽  
Hazard Ratios ◽  
Metastatic Lung ◽  
Death Receptor Ligand ◽  
One Year

e20508 Background: The American Cancer Society of Clinical Oncology used hazard ratios (HR) in its value framework as indicators of clinical response. Bevacizumab (Bev) and Pemetrexed (Peme) were introduced for non-squamous metastatic lung cancer prior to epidermal growth factor recognition. Objective: Analyze drug costs and HR in 1st-line advanced/metastatic lung cancer. Methods: Costs of Bev, Peme, Pembrolizumab (Pembro) and Atezolizumab (Atezo) were calculated x one year. Protocols and HR at 95% confidence intervals were quoted. Results: Median drug HR was 0.73. Bev costs were $132,314 and HR 0.79 (A. Sandler, 2006). Peme costs were $97,947, HR 0.63 (M. Zuchin, 2013) and 0.78 (PARAMOUNT). Costs of Pembro 2mg/Kg x 80 Kg were $125,770 compared with $157,313, the currently used 200 mg flat dose. Proportionate savings were noted over the 90-50 Kg weight. Pembro costs x 35 cycles increased to $317,450. In tumor progression score (TPS) > 50% (KEYNOTR-24), Pembro HR was 0.60. In KEYNOTE-042, HR in > 1.0% was 0.81 and improved to 0.69 in 50% with a net benefit of 14%. In squamous cell (KEYNOTE-407), Pembro+chemo HR was 0.64. Pembro+Peme+chemo costs were $255,160. In KEYNOTE-189, irrespective of program death receptor-ligand-1 (PD-L1), HR was 0.49, < 1.0% 0.59 and > 50% 0.42. The net benefit was 28%. Atezo+Bev combination costs were $287,314 and HR 0.78 (IMPOWER 150). In extensive small-cell, Atezo+chemo costs were $150,604 and HR 0.70 (IMPOWER 133). Conclusions: Pembro weight-adjusted dose resulted in significant cost saving over the fit-all 200mg. In 1st-line advanced/metastatic lung cancer, Pembro-Peme, irrespective of PD-L1, offered incomparable 0.49 HR at yearly costs of $255,160.

Costs of Extended Use of the Immune Check Point Inhibitors in 1st-line Non-Small Cell Lung Cancer

2021 ◽  
Author(s):  
Helmy M Guirgis
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Check Point ◽  
Small Cell Lung ◽  
Curative Intent ◽  
Check Point Inhibitors ◽  
One Year ◽  
The Impact

Aim: Cost-effectiveness in the health care system has been extensively investigated. Reports, however, on costs and the impact of extended use of the immune check point inhibitors (ICI) are rare. Pembrolizumab (Pembro) improved the 5-year overall survival in1st-line advanced/metastatic non-small cell lung cancer a/m-NSCLC. ICI are rather expensive, and costs are bound to increase with prolonged therapy. We purposed to focus on cost of extended ICI use beyond their indications in a/m-NSCLC. Methods: The 2020 annual posted drug costs were calculated in US$. Except for the one-year adjuvant Durv, used for curative intent, ICI costs were calculated for 2-years and beyond. Adverse events-treatment costs and generic chemo-drugs were not included. Results: ICI costs ranged from $103,400 to $168,948 with $148,431 mean. Adjuvant Durv one-year costs were $148,013. The 2-year Pembro costs in PD-L1 > 50% were $334,652, multiplying to >$836,630 after 5 years. Addition of 4 Peme cycles improved outcome regardless of PD-L1 at costs of $360,912. Costs of the 2-year Atezolizumab/Bevacizumab (Atezo/Bev) and one-year Peme were $722,977. Use of Biosimilar (Bio) saved $77,120. Atezo-Peme without Bev reduced costs to $422,725. Costs of Ipilimumab/Nivolumab (Ipi/Nivo) were $544,696. Adding 2 Peme cycles increased costs to $557,826. Extended for 6 months, the 2-year-costs of the 3 ICI combinations increased by 25% of the maintenance ICI. As compared with Pembro-Peme, the 2-year costs of Atezo/Bio-Bev-Peme were 2.00 higher, Atezo-Bio-Bev-Peme 1.79, Atezo-Pem 1.17, Ipi/Nivo 1.51 and Ipi/Nivo-Peme 1.55. The ratios would further separate with extended use beyond 2 years. Conclusions: ICI costs are determined by duration of therapy more than by the posted annual price. Costs of extended use call for guidance on therapy duration and emphasize the need for cost constraint-policies.

scholarly journals Heterogeneous Expression of Programmed Death Receptor-ligand 1 on Circulating Tumor Cells in Patients With Lung Cancer

2019 ◽  
Vol 20 (4) ◽  
pp. 270-277.e1 ◽  
Author(s):  
Yasuhiro Koh ◽  
Satomi Yagi ◽  
Hiroaki Akamatsu ◽  
Kuninobu Kanai ◽  
Atsushi Hayata ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Death Receptor ◽  
Receptor Ligand ◽  
Programmed Death ◽  
Heterogeneous Expression ◽  
Death Receptor Ligand

Costs and values of the immune check point inhibitors antibodies in non-small cell lung cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20644-e20644
Author(s):  
Helmy M. Guirgis ◽  
Corey J. Langer
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Check Point ◽  
Small Cell Lung ◽  
Probability Of Survival ◽  
Life Year Gain ◽  
Check Point Inhibitors ◽  
One Year

e20644 Background: Costs (C) and values (V) of the check point inhibitors antibodies have not been compared. Our objectives were to weigh and compare C and V of Nivolumab (Nivo), Atezolizumab (Atezo) and Pembrolizumab (Pembro) vs. Docetaxel (Doc) in 2nd-line non-small-cell lung cancer (NSCLC). Methods: Median overall survival gain over control (OS), hazard ratios (HR), doses and prices posted by parent companies were quoted. Probability of survival (PoS) was calculated as (1.0- HR). Values were computed at 4-week (w) as 4wC/PoS and one-year as C/life-year gain (LYG). Results: Doc OS was 72 days, HR not reported, generic 4wC < $500 and C/LYG 26,896. In comparison, in non-enriched non-squamous (sq-) Nivo C/LYG was 558,313, Atezo 618,244, Pembro 659,059. Nivo OS was 84, HR 0.73, 4wC $10,021 and 4wV 37,115 improving in > 10% PD-L1 positive to OS 264, HR 0.27 and 4wV 13,727. Atezo OS was 87, HR 0.73, 4wC $11,493 and 4wV 42,567 improving in medium- high PD-L1 to 150, 0.46 and 4wV 21,283 respectively. Pembro demonstrated OS 57, HR 0.71, 4wC $8,027 and 4wV 27,679 improving in > 50% PD-L1 to 201, 0.54 and 4wV 17,450. Conclusions: Doc, without accounting for adverse events and quality of life, remains a valuable drug in 2nd-line NSCLC. In PD-L1- enriched non-sq, Nivo, Atezo and Pembro consistently demonstrated marked V improvement to justify their C. The limited available data and the inherent problems of drug comparison preclude favoring one ICPIA over another. References: Doc: Shepherd FA et al. JCO 18:2095, 2000; Nivo: Checkmate 057, Brahmer JN et al. NEJM 373: 123, 2015; Atezo: POPLAR; Pembro: KEYNOTE-010.

The impact of PD-L1 on survival and values of nivolumab, atezolizumab, and pembrolizumab compared with docetaxel in second-line non-small cell lung cancer.

2018 ◽  
Vol 36 (5_suppl) ◽  
pp. 141-141
Author(s):  
Helmy M. Guirgis
Keyword(s):  
Lung Cancer ◽  
Adverse Events ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Death Receptor ◽  
Small Cell ◽  
Small Cell Lung ◽  
Check Point Inhibitors ◽  
One Year ◽  
The Impact

141 Background: The impact of programmed death receptor-ligand1 (PD-L1) on values of the immune check point inhibitors (ICPI) has received minimal attention. Objectives: Grade survival and weigh values of Nivolumab (Nivo), Atezolizumab (Atezo) and Pembrolizumab (Pembro) vs. Docetaxel (Doc) in 2nd-line non-squamous non-small-cell lung cancer (NSCLC). Methods: Previously reported median overall survival (OS), adverse events and prices posted by the parent companies were utilized. The OS gains in days over controls were graded (gr) from A to D. Docetaxel costs x 6 -12 cycles and ICPI x one year were calculated separately from adverse events treatment costs (AEsTC). Costs/life-year gain (C/LYG) were computed as drug C/OS gain x 360. Relative Values were expressed as $100,000/C/LYG. Results: Docetaxel costs of 9 cycles were $35,802, OS/gr 87/C, AEs gr ¾ > 20%, AEsTC $4,940 and C/LYG $148,146. Nivo, Atezo and Pembro gr ¾ < 20% were at $1,480 costs. In non-squamous NSCLC, Nivo OS/gr were 84/C and C/LYG $545,754. The results improved in PD-L1 > 10% to 264/A and $177,645 respectively. Atezolizumab demonstrated OS/gr 99/C and C/LYG $551,407 improving in PD-L1 50% to 348/A and $151,193. Pembrolizumab in PD-L1 > 1.0%, the OS/gr were 57/C and C/LYG $659,059 improving in > 50% to 201/A and $186,897. PD-L1 enrichment increased relative values of Nivo from 0.19 to 0.56, Atezo from 0.19 to 0.66 and Pembro from 0.15 to 0.53. Conclusions: In 2nd-line non-squamous NSCLC, the OS of Doc, Nivo, Atezo and Pembro were limited. In PD-L1 enriched, the ICPI resulted in unprecedented OS, improved grades and enhanced values at justifiable costs.

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