The overall 5-year survival for mCRC remains poor (14%) despite the use of current chemotherapeutic and biologic agents. Immunotherapy (IO) is a promising treatment option in tumors with a high mutational burden. This includes mCRC DNA dMMR tumors which have upregulation of immune checkpoints and a poorer prognosis. The CheckMate 142 phase II trial in pretreated dMMR mCRC patients using DAIO with N and I showed improved responses and disease control compared to N alone. The use of this DAIO has an anticipated budgetary impact on health care systems within the context of this potentially funded utilization of IO.
An estimation of the drug acquisition cost for N and I for new cases diagnosed in 2017 and treated upon relapse in Canada was undertaken. A cost estimate for N and I treatment in the first line of dMMR mCRC in relapses and de novo was undertaken should this be a future option. N and I drug costs per patient were calculated based on treatment indication, median number of cycles, standard dose/schedule as per the CheckMate 142 trial. The analysis was performed in Canadian dollars ($) and assumed complete drug delivery and uncomplicated cycles. The cost of N and I was obtained from the pan Canadian Oncology Drug Review (pCODR) costings for N in lung cancer and I in melanoma respectively. The number of target patients and N and I utilization was derived from constructed schema to give a budget impact estimate.
Estimated DAIO drug costs per treated patient are $131,040. Assuming 65% patients received first line chemotherapy, the cost of DAIO second line and third line in mCRC respectively ranges from $32.9 Million (M) – $50.7M and $17.8M – $24.7M. For 1st line DAIO in 65% of patients: the cost of treating early stage dMMR CRC which subsequently recurs would be $45.7M and the cost for treatment of dMMR de novo mCRC would be $22.8M. A sensitivity analysis was performed.
DAIO drug costs in dMMR mCRC potentially add a substantial cost burden to the publically funded Canadian healthcare system. As data evolves, longer duration of therapy and potential first line use will add further to the estimated budgetary impact.
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All authors have declared no conflicts of interest.