Background: The 2-year Pembrolizumab (Pembro), Atezolizumab (Atezo) and Cemiplimab (Cemi), monotherapy or combinations, prolonged overall survival (OS) in advanced/metastatic non-small cell lung cancer (a/m NSCLC). Pembro further demonstrated 5-year OS gain. One-year adjuvant Durvalumab (Durv) and Atezo significantly prolonged OS. Few cycles of neoadjuvant immune check point inhibitors (ICI) have resulted in positive outcomes. ICI costs are expensive, turning financially toxic on prolonged use. Comparative studies between the various ICI are unlikely to merge. Cost could play an important distinguishing role. There are unmet needs for innovative drug cost policies and reforms. Bundling and utilization thresholds on ICI extended cost based on a precedent of 2019 CAR-T of $450,000 were previously used. We aimed to test the impact of ICI duration use on costs
Methods: The posted annual drug prices were calculated.
Results: Estimated annual Pemetrexed (Peme) costs were $113,793, generic chemicals < $1,000 and Bevacizumab (Bev) $150,126 as compared with a mean 6 ICI of $148,000. Pembro 2-year costs were $334,652, significantly below the $450,000 threshold. The 5-year $836,630 were far above. Atezo + Bev+ Peme combination had the highest 2-year $722,977 costs. The lowest were demonstrated by Atezo + Peme at $422,685, Pembro + Peme $448,445 and Cemi + Peme $425,385, all below the $550,000. Costs further decreased by 20% using generics. Extending ICI use by 6-12 months beyond 2-years increased combination costs by 25-50%. Conversely, costs of 1-year Durva were $148,013, Atezo $154,446 and Nivolumab $159,589 as compared with $25,000 - $500,000 of 2-4 cycles neoadjuvant use. cycles of $25,000-$50,000. Conclusion: The impact of ICI duration of use on cost in lung cancer was significant.