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Alexander Kuhlmann
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OA 15 - Diagnostic Radiology, Staging and Screening for Lung Cancer II (ID 684)
- Event: WCLC 2017
- Type: Oral
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:Y. Satoh, Jin Mo Goo
- Coordinates: 10/18/2017, 14:30 - 16:15, Room 303 + 304
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OA 15.02 - Benefits, Harms, and Economic Efficiency of Low-Dose CT Lung Cancer Screening Strategies in a Population-Based Setting (ID 7999)
14:40 - 14:50 | Presenting Author(s): Alexander Kuhlmann
- Abstract
- Presentation
Background:
In lung cancer screening, a nodule management protocol describes nodule assessment and thresholds for nodule size and growth rate to identify patients who require immediate diagnostic evaluation or additional imaging exams. The NELSON and NLST clinical trials used different selection criteria and nodule management protocols. Several modelling studies have reported variations in screening outcomes and cost-effectiveness across selection criteria and screening intervals; however, the effect of variations in the nodule management protocol remains uncertain. This study evaluated the effects of the eligibility criteria and nodule management protocols on the benefits, harms, and cost-effectiveness of lung screening scenarios in a population-based setting in Germany.
Method:
We developed a modular microsimulation model: a biological module simulated individual histories of lung cancer development from carcinogenesis onset to death; a screening module simulated patient selection, screening-detection, nodule management protocols, diagnostic evaluation and screening outcomes. Benefits included mortality reduction, life years gained, averted lung cancer deaths. Harms were costs, false-positives, overdiagnosis. Comparator was no screening. Evaluated 57 screening scenarios included variations in selection criteria and thresholds for nodule size and growth rate.
Result:
Five years of annual screening resulted in an 11.3–12.6% lung cancer mortality reduction in the screened population. The efficient scenario included volumetric assessment, a threshold for a volume of 300 mm[3], and a threshold for a volume doubling time of 400 days. Assessment of volume doubling time is essential for reducing overdiagnosis and false-positives. Incremental cost-effectiveness ratios of the efficient scenarios were 19,389–23,804 Euro per life years gained and 178,673–285,630 Euro per averted lung cancer death.
Conclusion:
Lung cancer screening can be cost-effective in Germany. Along with the eligibility criteria, the nodule management protocol influences screening performance and cost-effectiveness. Definition of the thresholds for nodule size and nodule growth in the nodule management protocol should be considered in detail when defining optimal screening strategies.
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P3.07 - Immunology and Immunotherapy (ID 723)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Immunology and Immunotherapy
- Presentations: 1
- Moderators:
- Coordinates: 10/18/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P3.07-013 - Cost-Effectiveness of Immune Checkpoint Inhibitors in the Treatment of Advanced Non-Small Cell Lung Cancer (ID 9844)
09:30 - 09:30 | Presenting Author(s): Alexander Kuhlmann
- Abstract
Background:
Non-small cell lung cancer (NSCLC) is a leading cause of cancer related death worldwide. Late diagnosis and poor prognosis of advanced cancer are considered to be the main causes for the high mortality rates in NSCLC. Immune checkpoint inhibitors targeting programmed cell death protein 1 (PD1) demonstrated substantial improvements in overall survival (OS) compared with chemotherapy in previously treated patients with advanced NSCLC. However, the annual therapy costs are high (>EUR100,000 in Germany). The objectives of this study are to assess the cost-effectiveness of nivolumab and pembrolizumab in previously treated patients with advanced NSCLC from the perspective of the German statutory health insurance.
Method:
We developed a microsimulation model (discrete event simulation) to simulate the results of clinical trials and to extrapolate outcomes beyond the study duration. Clinical input parameters were gathered from published trial data (CheckMate017, CheckMate057, KEYNOTE-010). Kaplan-Meyer curves of progression free survival and OS were digitally reconstructed and survival analyses were conducted to inform model survival parameters. Utilities and cost data were extracted from published literature and German price databases. Cost-effectiveness analysis was performed for various PD-L1 expression levels. In each scenario, a Monte Carlo simulation with 10,000 iterations was performed to capture parameter uncertainty.
Result:
Additional cost per quality adjusted life year (QALY) gained of nivolumab vs. docetaxel in squamous-cell NSCLC, nivolumab vs. docetaxel in nonsquamous-cell NSCLC and pembrolizumab vs. docetaxel were EUR132,248 (EUR113,483 - EUR156,045), EUR197,187 (EUR171,718 - EUR228,407) and EUR208,652 (EUR182,492 - EUR237,161) respectively (table 1). Treating only patients with PD-L1-positive tumors substantially reduced additional costs per QALY gained for nivolumab in nonsquamous-cell NSCLC and for pembrolizumab but the incremental cost-effectiveness ratio still considerably exceeded EUR100,000 per QALY. Figure 1
Conclusion:
PD1-inhibitors nivolumab and pembrolizumab are likely not cost-effective in previously treated patients with advanced NSCLC, even in patients with substantial PD-L1 expression, at current price levels in Germany.
