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R.A. De Mello
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P1.11 - Patient Advocacy (ID 697)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Patient Advocacy
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.11-001 - Economic Impact of Immune Checkpoint Inhibitor Therapy in Brazil and Strategies to Improve Access (ID 7516)
09:30 - 09:30 | Author(s): R.A. De Mello
- Abstract
Background:
Immunotherapy was elected by ASCO as the most important advance in Oncology in the last 2 consecutive years. Harnessing the immune system to fight cancer cells has already changed clinical practice. Nevertheless, the cost of immune checkpoint inhibitors is a limitation to their incorporation in several countries, including Brazil. The objective of this study was to estimate the economic impact of immunotherapy and make suggestions in order to improve access for patients who benefit the most from treatment.
Method:
We assessed Brazilian cancer epidemiology data and the international literature to estimate the number of eligible patients each year. The authors estimated the economic impact according to the local medication acquisition costs converted to US dollars. The median duration of the treatment was based upon the randomized clinical trials.
Result:
We assessed 3 different agents (and one combo) for 4 indications in the treatment of lung cancer. The results are summarized in the table below.Drug NSCLC 1L NSCLC 2L TOTAL Number of Eligible Patients (% of all cancer patients) Increase in Cancer Drug Total Expenditure Cost in the Public Health System Additional Cost Per Citizen LYG Cost per LYG Nivo NA 173.0 mi All Comers 173.0 mi -10%: 154.1 -20%: 135.1 4,733 (1.0) +21.6% +19.3% +16.9% $0.90 $0.77 $0.68 0.57 $99,467 Pembro 354.0 mi PD-L1>50% (monoTx) 898.5 mi PD-L1<50% (+chemo) 100.0 mi PD-L1>1% 1,352 mi -10%: 1,211 -20%: 1,070 16,362 (3.5) +169% +151% +134% $6.76 $6.06 $5.35 Mono 0.73 +chemo 0.55 2L 0.69 $156,164 $200,684 $49,007 Atezo NA 255.6 mi All Comers 255.6 mi -10%: 228.4 -20%: 201.2 4,733 (1.0) +32.0% +28.6% +25.2% $1.28 $1.14 $1.01 0.74 $103,095
Conclusion:
The current cost of immune checkpoint inhibitors is prohibitive in the public health system in Brazil. While the country’s GDP per capita is 78% lower than that of the US, immune checkpoint inhibitors have similar prices in both. Biomarker selection, posology and lower cost drugs help decrease the total economic impact of therapy. Price discrimination and volume discounts would help improve access. Further studies and discussion with all stakeholders is needed to identify patients who would benefit the most and to implement strategies to increase access to these potentially life-saving therapies.
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P2.03 - Chemotherapy/Targeted Therapy (ID 704)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Chemotherapy/Targeted Therapy
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.03-006 - How Many Years of Life Have We Lost in Brazil Due to the Lack of Access to Anti-EGFR TKIs in the National Public Health System? (ID 7514)
09:30 - 09:30 | Author(s): R.A. De Mello
- Abstract
Background:
Lung cancer is the fourth most common cancer in Brazil with 28,220 new cases in 2017. It is the main cause of cancer-related deaths with 23,393 deaths in 2013. In the 2000s, better understanding of molecular pathways led to the development of targeted treatments. The introduction of EGFR tyrosine kinase inhibitors (TKI) led to significant improvements in Response Rate and Progression-Free Survival for patients with activating mutations. Nevertheless, this treatment is not available in the Brazilian Public Health System based upon its costs andthe absence of Overall Survival gain in randomized clinical trials. The aim of this study was to assess the potential number of life-years lost and the cost associated with lack of treatment.
Method:
We estimated the number of eligible cases for treatment using epidemiological data from the National Cancer Institute (INCA) plus the national database on the frequency of EGFR gene mutations since July 2010 (gefitinib approval in Brazil). We based the differences in survival between patients treated with EGFR TKIs and chemotherapy using the curves of The Lung Cancer Mutation Consortium. The costs of TKI treatment were based on the national reference ($1,200 monthly) and was compared with the amount reimbursed by the Brazilian Public Health System for chemotherapy ($350 monthly).
Result:
The number of eligible cases for EGFR TKIs in the Brazilian Public Health System is around 2,224 patients each year. Since gefitinib approval, the estimated number of years of life lost due to the lack of access to EGFR TKIs was 2,668 annually. Considering only drug acquisition costs, we need nearly 150 million dollars to incorporate TKIs into the public health care system. The cost per incremental life-year gained over chemotherapy was 585 dollars. Although our analysis does not consider quality-of-life, the cost of one life-year gain is lower than three times the Brazilian GDP per capita (approximately 35,000 dollars).
Conclusion:
The lack of access to EGFR TKIs cost more than 18,676 years of live in Brazil in the past 7 years. Treatment would also be cost-effective.
