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P1.11-001 Economic Impact of Immune Checkpoint Inhibitor Therapy in Brazil and Strategies to Improve Access
S2026
Journal of Thoracic Oncology
Patients were initially categorized according to the decision to undergo oncologic treatment (therapeutic or palliative) or to receive no oncologic treatment. Patients were further stratified into those who received PC consultation, those referred to hospice (without PC consultation), or those who received neither based on clinical stage. Result: We identified 182 stage cIV patients, of which 16% (30/182) received a PC consultation, 39% (71/182) were referred to hospice, and 45% (81/182) received neither. Of the stage cIV patients, those who received oncologic treatment were less likely to receive PC or hospice services (51%, 78/154) than patients without treatment (82%, 23/28); p¼0.002 (Fig). The figure also demonstrates services utilized by patients of all stages that were ineligible/refused oncologic treatment (48/406). Conclusion: PC and hospice services were underutilized in patients with advanced disease and in those likely to reap benefit from these resources. In addition, stage IV patients receiving oncologic treatment were less likely to receive PC or hospice services than patients undergoing no oncologic treatment. Quality improvement interventions and referral triggers targeting the implementation of PC and hospice services early in patient management are needed to meet patient’s global oncologic needs. Keywords: palliative care, Advanced Non-Small Cell Lung Cancer, Hospice
Vol. 12 No. 11S2
patients who benefit the most from treatment. Method: We assessed Brazilian cancer epidemiology data and the international literature to estimate the number of eligible patients each year. The authors estimated the economic impact according to the local medication acquisition costs converted to US dollars. The median duration of the treatment was based upon the randomized clinical trials. Result: We assessed 3 different agents (and one combo) for 4 indications in the treatment of lung cancer. The results are summarized in the table. Conclusion: The current cost of immune checkpoint inhibitors is prohibitive in the public health system in Brazil. While the country’s GDP per capita is 78% lower than that of the US, immune checkpoint inhibitors have similar prices in both. Biomarker selection, posology and lower cost drugs help decrease the total economic impact of therapy. Price discrimination and volume discounts would help improve access. Further studies and discussion with all stakeholders is needed to identify patients who would benefit the most and to implement strategies to increase access to these potentially life-saving therapies. Keywords: pharmacoeconomics, Immunotherapy, health policy
P1.11-002 Lung Cancer in Nonagenarian Patients C.C. Hsu, Y. Luo, Y. Chen Department of Chest Medicine, Taipei Veterans General Hospital, Taipei City/TW
P1.11-001 Economic Impact of Immune Checkpoint Inhibitor Therapy in Brazil and Strategies to Improve Access P. Aguiar Jr,1 B. Gutierres,2 C. Barreto,3 R.A. De Mello,4 H. Tadokoro,5 A. Del Giglio,1 G. Lopes6 1Faculdade de Medicina Do Abc, Santo Andre/BR, 2Universidade Paulista, São Paulo/BR, 3 Beneficencia Portuguesa de São Paulo, São Paulo/BR, 4Biomedical Sciences and Medicine / Oncology Division, University of Algarve, Faro/ PT, 5Universidade Federal de São Paulo, São Paulo/BR, 6Global Oncology, Sylvester Comprehensive Cancer Center at the University of Miami, Miami, FL/US Background: Immunotherapy was elected by ASCO as the most important advance in Oncology in the last 2 consecutive years. Harnessing the immune system to fight cancer cells has already changed clinical practice. Nevertheless, the cost of immune checkpoint inhibitors is a limitation to their incorporation in several countries, including Brazil. The objective of this study was to estimate the economic impact of immunotherapy and make suggestions in order to improve access for
Drug
NSCLC1L
NSCLC2L
TOTAL
Nivo
NA
173.0 mi All Comers 100.0 mi PD-L1>1%
173.0 154.1 1,352 1,211
Background: More than half lung cancer patients were aged more than 65-year-old. However the information in elderly patients is few, especially in nonagenarian (more than 90 year old). Method: We retrospectively collected clinical data of the lung cancer patient aged more than 90 year old between 2010 and 2014 in single medical center in Taiwan. The characteristics, treatment modality, and survival time were analyzed. Result: Eighty-three patients were enrolled: 76 patients (91.6%) were non-small cell carcinoma (NSCLC), and 7 patients (8.4%) were small cell carcinoma (SCLC), with the median overall survival (OS) of 30 and 13 weeks, p¼0.005. Nine patients were stage I (10.8%), 4 patients were stage II (4.8%), 11 patients were stage III (13.3%), and 59 patients were stage IV (71.7%), with the median OS of 142, 79, 33, and 21 weeks for stage I, II, III, and IV, p<0.001. Better performance status (PS) had longer OS (median OS of 79, 66, 24, 12, and 3 weeks in PS of 0, 1, 2, 3, 4, p<0.001). Patients of simplified comorbidity score (SCS) >9 had shorter OS, but no statistical significance (median OS of 12 and 32 weeks in >9 and 9 group, p¼0.065). For first-line treatment, 61.5% (8 in 13 stage I and II patients) received curative radiotherapy. For stage III patients, 63.6% (7 in 11 patients) received either radiotherapy or chemotherapy alone without concurrent chemo-radiotherapy; in stage IV, 59.3% (35 in 59 patients) received either chemotherapy or targeted therapy. Tumor EGFR mutation status in 30 of 46 stage IV non-squamous NSCLC patients: 55.6% was wild type and L858R was the most frequent. The response patterns in the E19D/L858R/
Number of Eligible Patients (% of all cancer patients) mi -10%: 4,733 (1.0) -20%: 135.1 mi -10%: 16,362 (3.5) -20%: 1,070
Pembro 354.0 mi PD-L1>50% (monoTx) 898.5 mi PD-L1<50% (+chemo) Atezo NA 255.6 mi All 255.6 mi -10%: 4,733 (1.0) Comers 228.4 -20%: 201.2
Increase in Cancer Drug Total Expenditure Cost in the Public Health System
Additional Cost Per Citizen LYG
+21.6% +19.3% +16.9% $0.90 $0.77 $0.68 +169% +151% +134% $6.76 $6.06 $5.35 +32.0% +28.6% +25.2% $1.28 $1.14 $1.01
0.57
Cost per LYG $99,467
Mono 0.73 $156,164 $200,684 +chemo $49,007 0.55 2L 0.69 0.74 $103,095
Journal of Thoracic Oncology
Patients were initially categorized according to the decision to undergo oncologic treatment (therapeutic or palliative) or to receive no oncologic treatment. Patients were further stratified into those who received PC consultation, those referred to hospice (without PC consultation), or those who received neither based on clinical stage. Result: We identified 182 stage cIV patients, of which 16% (30/182) received a PC consultation, 39% (71/182) were referred to hospice, and 45% (81/182) received neither. Of the stage cIV patients, those who received oncologic treatment were less likely to receive PC or hospice services (51%, 78/154) than patients without treatment (82%, 23/28); p¼0.002 (Fig). The figure also demonstrates services utilized by patients of all stages that were ineligible/refused oncologic treatment (48/406). Conclusion: PC and hospice services were underutilized in patients with advanced disease and in those likely to reap benefit from these resources. In addition, stage IV patients receiving oncologic treatment were less likely to receive PC or hospice services than patients undergoing no oncologic treatment. Quality improvement interventions and referral triggers targeting the implementation of PC and hospice services early in patient management are needed to meet patient’s global oncologic needs. Keywords: palliative care, Advanced Non-Small Cell Lung Cancer, Hospice
Vol. 12 No. 11S2
patients who benefit the most from treatment. Method: We assessed Brazilian cancer epidemiology data and the international literature to estimate the number of eligible patients each year. The authors estimated the economic impact according to the local medication acquisition costs converted to US dollars. The median duration of the treatment was based upon the randomized clinical trials. Result: We assessed 3 different agents (and one combo) for 4 indications in the treatment of lung cancer. The results are summarized in the table. Conclusion: The current cost of immune checkpoint inhibitors is prohibitive in the public health system in Brazil. While the country’s GDP per capita is 78% lower than that of the US, immune checkpoint inhibitors have similar prices in both. Biomarker selection, posology and lower cost drugs help decrease the total economic impact of therapy. Price discrimination and volume discounts would help improve access. Further studies and discussion with all stakeholders is needed to identify patients who would benefit the most and to implement strategies to increase access to these potentially life-saving therapies. Keywords: pharmacoeconomics, Immunotherapy, health policy
P1.11-002 Lung Cancer in Nonagenarian Patients C.C. Hsu, Y. Luo, Y. Chen Department of Chest Medicine, Taipei Veterans General Hospital, Taipei City/TW
P1.11-001 Economic Impact of Immune Checkpoint Inhibitor Therapy in Brazil and Strategies to Improve Access P. Aguiar Jr,1 B. Gutierres,2 C. Barreto,3 R.A. De Mello,4 H. Tadokoro,5 A. Del Giglio,1 G. Lopes6 1Faculdade de Medicina Do Abc, Santo Andre/BR, 2Universidade Paulista, São Paulo/BR, 3 Beneficencia Portuguesa de São Paulo, São Paulo/BR, 4Biomedical Sciences and Medicine / Oncology Division, University of Algarve, Faro/ PT, 5Universidade Federal de São Paulo, São Paulo/BR, 6Global Oncology, Sylvester Comprehensive Cancer Center at the University of Miami, Miami, FL/US Background: Immunotherapy was elected by ASCO as the most important advance in Oncology in the last 2 consecutive years. Harnessing the immune system to fight cancer cells has already changed clinical practice. Nevertheless, the cost of immune checkpoint inhibitors is a limitation to their incorporation in several countries, including Brazil. The objective of this study was to estimate the economic impact of immunotherapy and make suggestions in order to improve access for
Drug
NSCLC1L
NSCLC2L
TOTAL
Nivo
NA
173.0 mi All Comers 100.0 mi PD-L1>1%
173.0 154.1 1,352 1,211
Background: More than half lung cancer patients were aged more than 65-year-old. However the information in elderly patients is few, especially in nonagenarian (more than 90 year old). Method: We retrospectively collected clinical data of the lung cancer patient aged more than 90 year old between 2010 and 2014 in single medical center in Taiwan. The characteristics, treatment modality, and survival time were analyzed. Result: Eighty-three patients were enrolled: 76 patients (91.6%) were non-small cell carcinoma (NSCLC), and 7 patients (8.4%) were small cell carcinoma (SCLC), with the median overall survival (OS) of 30 and 13 weeks, p¼0.005. Nine patients were stage I (10.8%), 4 patients were stage II (4.8%), 11 patients were stage III (13.3%), and 59 patients were stage IV (71.7%), with the median OS of 142, 79, 33, and 21 weeks for stage I, II, III, and IV, p<0.001. Better performance status (PS) had longer OS (median OS of 79, 66, 24, 12, and 3 weeks in PS of 0, 1, 2, 3, 4, p<0.001). Patients of simplified comorbidity score (SCS) >9 had shorter OS, but no statistical significance (median OS of 12 and 32 weeks in >9 and 9 group, p¼0.065). For first-line treatment, 61.5% (8 in 13 stage I and II patients) received curative radiotherapy. For stage III patients, 63.6% (7 in 11 patients) received either radiotherapy or chemotherapy alone without concurrent chemo-radiotherapy; in stage IV, 59.3% (35 in 59 patients) received either chemotherapy or targeted therapy. Tumor EGFR mutation status in 30 of 46 stage IV non-squamous NSCLC patients: 55.6% was wild type and L858R was the most frequent. The response patterns in the E19D/L858R/
Number of Eligible Patients (% of all cancer patients) mi -10%: 4,733 (1.0) -20%: 135.1 mi -10%: 16,362 (3.5) -20%: 1,070
Pembro 354.0 mi PD-L1>50% (monoTx) 898.5 mi PD-L1<50% (+chemo) Atezo NA 255.6 mi All 255.6 mi -10%: 4,733 (1.0) Comers 228.4 -20%: 201.2
Increase in Cancer Drug Total Expenditure Cost in the Public Health System
Additional Cost Per Citizen LYG
+21.6% +19.3% +16.9% $0.90 $0.77 $0.68 +169% +151% +134% $6.76 $6.06 $5.35 +32.0% +28.6% +25.2% $1.28 $1.14 $1.01
0.57
Cost per LYG $99,467
Mono 0.73 $156,164 $200,684 +chemo $49,007 0.55 2L 0.69 0.74 $103,095