Abstract
Background: We previously reported that the 2-year costs of the immune check inhibitors (ICI) were equitable with outcomes. Extended use multiplied costs. Nivolumab neoadjuvant plus chemotherapy improved event-free survival in early resectable lung cancer at low cost. Neoadjuvant is a novel advance in earlier cancer treatment. The targeted therapy Osimertinib is currently utilized as neoadjuvant, adjuvant and in advanced/metastatic lung cancer with cost increasing yearly with further use. We aimed to quantify the cost and savings of ICI and targeted therapy in earlier vs advanced cancer stages in multiple solid tumors.
Methods: Annual 2019-2020 costs of Osimertinib were calculated ad monthly optimal dose x 12. Costs of ICI were calculated as dose x mg/m2 or per 80 kg x price x number of cycles per year.
Results: The 2-year Osimertinib cost in metastatic disease was $496,744, adjuvant 1-year $248,372 and neoadjuvant $31,046. Estimated neoadjuvant cost savings over 1-year were $217,326.
Pembrolizumab $134,796 annual cost was the median of 5- evaluated ICI. It is used as adjuvant at half the 2-year cost. Extended therapy by 6-12 months, beyond the 2-year approval, added an extra $67,398-$134,796.
Durvalumab following chemo-radiation, (Pacific) was approved in unresectable stage III NSCLC x 1-year at $148,007, saving a 2nd year-cost. Adjuvant Atezolizumab 1-year cost in 1st-line was $124,761. Approval was based on improving the disease-free survival using 4 cycles + chemo in resected stage II-IIIA lung (Impower010), Cost was $35,644 cost with $89,117 savings.
In the neoadjuvant space, Nivolumab + chemotherapy improved event-free survival in resectable lung cancer (Forde, 2022) at $31,425, saving $137,423. In early-stage triple negative breast cancer (GeparoNuevo-NCTO2685059), 8-cycle Durvalumab prolonged survival at $45,464. Cemiplimab x 4-cycle in stage II to IV, cutaneous squamous-cell carcinoma resulted in complete pathological response (Gross, 2022) at $35,652 vs 1-year $125,108. In early colorectal cancer (NICHE-2), 2-cycle Nivolumab plus 1- low-dose Ipilimumab followed by surgery resulted in major pathological response at $24,927.
Conclusions: Neoadjuvant Osimertinib and ICI cost a small fraction resulting in significant savings in early-stage lung cancer treatment. Cost advantages in other solid tumors warrant further confirmation.