Oncology Central

Cost–effectiveness and budget impact of lung cancer immunotherapy in South America: strategies to improve access


Aim: Immune checkpoint inhibitors revolutionized the treatment of non-small-cell lung cancer, although their costs are a limitation. Methods: The number of patients with non-small-cell lung cancer eligible for immunotherapy was estimated using local epidemiology data. We extracted survival data from RCTs to estimate the life-years saved in a 5-year time horizon. All costs were in local prices converted to US dollars. Results: In the first-line, the budget impact of pembrolizumab decreased by 35% through risk-sharing. In the second-line, patient selection by programmed-death receptor ligand 1 expression decreased the budgetary impact by 45%, and improved cost–effectiveness. Immunotherapy was more cost-effective in the first-line. Conclusion: Given current pricing, immune checkpoint inhibitors are cost-prohibitive in the majority of South American health services. Nevertheless, several strategies should improve access to immunotherapy.

Lung cancer, the fourth most common cancer in Brazil (7% of all neoplasms) with 28,220 new cases in 2016 (13.58 new cases per 100,000 citizens) [1], is the main cause of cancer-related mortality in the country, with 23,393 deaths in 2013 [2]. These numbers are similar to epidemiological data seen in Argentina where there are more than 10,000 new cases each year (near 10% of all neoplasms with 23.48 new cases per 100,000 citizens) [3]. In Peru, as there are fewer smokers, the burden is somewhat less, but lung cancer is still important because of nonsmokers that also develop lung cancer, although in a less frequency compared with smokers. As a result, in Peru there were 1828 new cases in 2016 (4% of all neoplasms with 5.75 new cases per 100,000 citizens).

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