Costs of Target Therapy and Proportionality to Number of Purchases: Propose Using Maintenance Dose and Limited Duration
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Abstract
The 2-year costs of the immune check point inhibitors (ICI) were equitable with overall survival in advanced/metastatic non-small lung cancer. Target therapy (TT) is presently continued till disease progression or toxicity. The TT 2-3-year costs were justified in view of outcome and safety. Economically, what matters most is duration of use beyond 3-years. Li et al (2022)) identified the cost burden of prolonged TT administration. Guirgis (2023) suggested using caps to limit costs. The current cost policy of continued TT is untenable, and a fresh perspective is warranted.
Objectives: 1-Focus on the deleterious cost impact of prolonged TT. 2-Propose using maintenance doses at 50% of the current recommendations and 4-year-limit.
Methods: The ICI costs were calculated as dose in mg x price x number of cycles and TT as the monthly optimal dose x 12.
Results: The 2019 Pembrolizumab, ICI prototype, was at $134,796 cost in 2018-19, increasing to $190,400 in 2023. The median cost of 5-ICI was $163,640. The 3-month $47,700 cost, if therapy extended beyond 2-years, was unnecessary due lack of further survival. The annual Osimertinib cost, TT prototype, was $229,600, the median of 5-TT. Costs multiplied with each extended year.
We reasoned that if 3000 United States patients be treated by all TT at $229,600 for 5-years, the cost would mount to $344,000,000. If used for 4-years, the cost would drop to $2,755,200,000. Treating 9000 patients in the European nations for 5-years would cost $10,332,000,000 and 4-years $8,265,600,000. Using TT dose as maintenance at 50% of the current recommendations would further cut costs.
Conclusion: Costs of TT were proportional to number of purchases. The proposed TT maintenance dose and the 4-year-limit on duration of use in advanced lung cancer would drastically cut costs. Clinical studies are warranted to ensure the safety of our proposal.
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References
2. Reck M, Rodriguez-Abreu D, Robinson AG, et al. Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med. 375:823–1833, 2016.
3. Herbst RS, Baas P, Kim D-W, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-postive, advanced non-small-cell lung cancer (KEYNOTE -010): A randomised controlled trial. Lancet 387: 1540-1550, 2016.
4. Herbst RS, Gluseppe G, de Marinis F, et al. Atezolizumab for First-Line Treatment of PD-L1–Selected Patients with NSCLC. N Engl J Med. 383,1328-1339. 2020.
5. Sezer A, Kilickap S, Gümüş M, et al. Cemiplimab monotherapy for first-line treatment of advanced non-small-cell lung cancer with PD-L1 of at least 50%: a multicentre, open-label, global, phase 3, randomised, controlled trial. Lancet. 397(10274):592-604
6. Guirgis HM. The Impact of The Immune Check Point on Cost in Lung Cancer: Duration of use. ESMED, July 31, 2022. Medical Research Archives, [online] 10(7). https://doi.org/10.18103/mra.v10i7.2859. ISSN: 2375-1924.
7. Li M, Liao K, Pan I-Wen et al. Growing Financial burden from high cost targeted oral anticancer medicines among Medicare beneficiaries with cancer. JCO oncology practice ,18,11,759, 2002.
8. Guirgis, Helmy M. Target Therapy vs the Immune Check Point Inhibitors in Lung Cancer: Costs and Caps Platform. ESMED February 2023.
9. Herbest RS, Wu Yi-long, John T, Adjuvant Osimertinib for Resected EGFR-Mutated Stage IB-IIIA Non–Small-Cell Lung Cancer: Updated Results from the Phase III Randomized ADAURA Trial, J Clin Oncol, 2023 Jan 31; JCO2202186. doi: 10.1200/JCO.22.02186.
10. Lv C, Fang W, Wu N, et al. Osimertinib as Neoadjuvant Therapy for EGFR-Mutant Resectable Stage II–IIIB Lung Adenocarcinoma. Lung Cancer; 2023 Feb 17; 178,151-156.
11. Guirgis, H, Cost matters. journal of Cancer & Oncology (OAJCO) Commentary Volume 7 Issue 1, April 19, 2023. DOI: 10.23880/oajco-16000184
12. Guirgis, HM. Costs of extended immune check point inhibitors treatment in advanced/metastatic lung cancer: Bundling of cost proposal. ASCO May-June 2020 annual meeting, Chicago, abstract 291815.
13. Kline RK. Bundled Payment Models in Oncology: Learning to Think in New Ways DOI: 10.1200/OP.20.00735 JCO Oncology Practice, Published online February 04, 2021, PMID: 33539197.
14. Schnipper LE, Davidson NE, Wollins DS, et al. American Society of Clinical Oncology statement: A framework to assess the value of cancer treatment options. J Clin Oncol. June 22, 2015.
15. Cherny NI, Sullivan R, Dafni U, et al. A standardized, generic, validated approach to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies. The European Society for Medical Oncology: magnitude of clinical benefit scale (ESM-MCBS): Oxford University Press; 2015.
16. Siegel JE, Weinstein MC, Russell LB, et al. Panel on cost-effectiveness in health and medicine. Recommendations for reporting cost effectiveness analyses. JAMA. 276(16):1339–1341,1996.
17. Dagogo-Jack I, Oxnard GR, Evangelist M, et al. Phase II Study of Lorlatinib in Patients With Anaplastic Lymphoma Kinase–Positive Lung Cancer and CNS-Specific Relapse.10.1200/PO.21.00522 JCO Precision Oncology no. 6 (2022) e2100522. Published online May 18, 2022.
18. Peppercorn, J. The impact of financial toxicity on cancer care. Clin adv, Hem & Onc. 21, October 2023.