Abstract 611P
Background
Immune checkpoint inhibitors (ICIs) in lung cancer have been increasingly indicated for perioperative treatment. Several ICIs are already available for neoadjuvant and adjuvant chemotherapy, and the FDA approved pembrolizumab for sandwich therapy in 2023. The use of ICIs has led to long-term improvements in prognosis, but the high cost of drugs has increased the medical expenses. We evaluated the cost-effectiveness of perioperative ICI therapy with non-small cell lung cancer in Japan, the United States, and Brazil.
Methods
Hazard ratios (HRs) of disease-free survival (DFS) and overall survival (OS) for neoadjuvant/adjuvant chemotherapy and neoadjuvant/adjuvant/sandwich therapy with ICI were estimated from pivotal phase III trials using network meta-analysis (NMA). A partitioned survival model estimated quality-adjusted life years (QALYs) and life years (LYs). Costs included drug and hospitalization costs based on standard regimens as of April 2023, discounted at 2% annually.
Results
In Japan, ICER per QALY for neoadjuvant chemotherapy compared to no perioperative treatment was ¥714,940($4,468). In addition, ICER per QALY for neoadjuvant therapy by ICI compared to neoadjuvant chemotherapy was ¥5,285,770($33,036) ($1=∖160). ICERs for other regimens were not calculated due to dominance. In the US and Brazil, ICERs for neoadjuvant chemotherapy were $32,726 and $29,320 respectively and ICERs for neoadjuvant therapy by ICI were $228,467 and $92,573 respectively.
Conclusions
The ICER threshold in Japan is generally ¥5 million and ¥7.5 million for sensitive drugs such as anticancer agents. The ICER of neoadjuvant chemotherapy was lower than the former threshold, and the ICER of neoadjuvant nivolumab was lower than the latter threshold only. These results suggest neoadjuvant nivolumab and neoadjuvant chemotherapy are cost-effective in Japan. The US and Brazil were less cost-effective than Japan due to the relatively high price of nivolumab compared to Japan.
Clinical trial identification
Editorial acknowledgement
During the preparation of this work the author(s) used ChatGPT 4o in order to adjust the number of characters and improve the accuracy of the text.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
T. Aranishi: Financial Interests, Personal, Stocks/Shares: Eli Lilly, Chugai pharmaceutical; Other, Personal, Member: Eli Lilly. T. Shukuya: Financial Interests, Personal and Institutional, Local PI: AstraZeneca, Chugai pharmaceutical, MSD, Novartis; Financial Interests, Personal and Institutional, Speaker’s Bureau: AstraZeneca, Chugai pharmaceutical, Boehringer Ingelheim, MSD, Novartis; Financial Interests, Personal and Institutional, Research Funding: Chugai pharmaceutical, Boehringer Ingelheim; Financial Interests, Personal, Speaker’s Bureau: Eli Lilly, Ono Pharmaceutical, Merck, Takeda pharmaceutical, Pfizer, Daiichi Sankyo pharmaceutical, Taiho pharmaceutical, Bristol Myers Squibb, Eisai, Nippon Kayaku, Amgen. D.P. Carbone: Financial Interests, Personal, Advisory Board: Iovance Biotherapeutics, Mirati Therapeutics, Arcus Biosciences, Roche, AbbVie, Regeneron, Merck Sharp Dohme, Genentech, Novocure, OncoHost, AstraZeneca, Amgen, Daiichi Sankyo, Lilly, Janssen, Johnson & Johnson, Pfizer; Financial Interests, Personal, Other, Consulting: BMS Israel, Novartis, Johnson & Johnson; Financial Interests, Personal, Other, Honoraria: AstraZeneca; Financial Interests, Personal, Other, Meet the Expert: Pfizer Egypt; Financial Interests, Personal, Other, Global Lung Expert Input Forum: Merck US; Financial Interests, Personal, Invited Speaker: Roche, AstraZeneca, BMS Brazil, Merck, Merck, Lumanity, DAVA; Financial Interests, Personal, Other, DMC Meeting: AbbVie; Financial Interests, Personal, Full or part-time Employment: The Ohio State University Comprehensive Cancer Center. K. Takahashi: Financial Interests, Personal, Invited Speaker: AstraZeneca, Chugai pharmaceutical, Boehringer Ingelheim, MSD, Ono Pharmaceutical, Takeda pharmaceutical, Pfizer, Daiichi Sankyo Pharmaceutical, Bristol Myers Squibb, Nippon Kayaku; Non-Financial Interests, Personal, Speaker, Consultant, Advisor: Eli Lilly, Merck, Novartis, Taiho pharmaceutical, Amgen; Non-Financial Interests, Personal, Other: Eisai; Financial Interests, Institutional, Research Funding: Chugai pharmaceutical, Ono Pharmaceutical, MSD; Financial Interests, Institutional, Research Grant: Boehringer Ingelheim, Chugai Pharmaceutical, KYORIN Pharmaceutical , Nippon Kayaku, Taiho pharmaceutical; Non-Financial Interests, Personal, Officer: Chairman of the Board of Directors/The Japanese Respiratory Society. All other authors have declared no conflicts of interest.