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Poster Display session 1

5405 - Estimating the cost and survival impact of new aNSCLC therapies in Canada with the iTEN model


28 Sep 2019


Poster Display session 1


Tumour Site

Non-Small Cell Lung Cancer


Parneet Kaur Cheema


Annals of Oncology (2019) 30 (suppl_5): v602-v660. 10.1093/annonc/mdz260


P.K. Cheema1, W.K. Evans2, R. Burkes3, R. Sangha4, C. Ho5, P. Wheatley-Price6, D. Boehm7, J. Venkatesh7, S. Walisser8, D. Grima9, D. Moldaver9, M. Hurry10

Author affiliations

  • 1 Faculty Of Medicine, William Osler Health System, University of Toronto, L693J7 - Toronto/CA
  • 2 Prevention, McMaster University, ON L8S 4K1 - Hamilton/CA
  • 3 Cancer Clinical Research Unit, Mount Sinai Hospital, M5G 1X5 - Toronto/CA
  • 4 Department Of Oncology, University of Alberta Cross Cancer Institute, T6G 1Z2 - Edmonton/CA
  • 5 Medical Oncology, BC Cancer Agency, V5Z 4E6 - Vancouver/CA
  • 6 Medical Oncology Department, The Ottawa Hospital Regional Cancer Centre, K1H 8L6 - Ottawa/CA
  • 7 Oncology Pharmacy Services, Saskatchewan Cancer Agency, S4W 0G3 - Regina/CA
  • 8 Medical Oncology, BC Cancer Agency (retired), V5Z 4E6 - Vancouver/CA
  • 9 Health Economics & Modeling, Cornerstone Research Group, L7n3h8 - Burlington/CA
  • 10 Health Outcomes Research, AstraZeneca Canada, L4Y 1M4 - Mississauga/CA


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Abstract 5405


Novel therapies are replacing established treatment options for patients with advanced non-small cell lung cancer (aNSCLC), which poses a challenge to healthcare budgets. The impact of Treatment Evolution in NSCLC (iTEN) model is a validated discrete event patient simulation designed to estimate the impact of treatment sequencing in aNSCLC. The impact of five novel therapies (osimertinib, alectinib, brigatinib, dabrafenib and trametinib, and pembrolizumab combination therapy) changing aNSCLC management in Canada was modelled.


Current Canadian treatment practices were established via a modified Delphi process with Canadian clinical experts. The table presents potential treatment sequences for biomarker positive aNSCLC with the novel therapies. Clinical efficacy of treatments was estimated from Kaplan–Meier progression-free and overall survival data, as previously described (Moldaver et al. 2018). Modelled costs (2018 CDN $) included drug acquisition and administration costs and the costs of ongoing monitoring, imaging, physician visits, end-of-life, best supportive care, and adverse event management. A treatment rate of 100% in the first-line and 60% thereafter was modelled.Table:

1582P Biomarker positive aNSCLC therapy

1LOsimertinib*Alectinib*Dabrafenib plus trametinib*PembrolizumabPembrolizumab plus chemotherapy*
2LPDBrigatinib*IO for those PD-L1 ≥ 50% PD for remainderPDDocetaxel
3LI-OPDSwitch (PD to I-O and I-O to PD)DocetaxelErlotinib

Therapies with an asterisk (*) are new to Canada BSC, best supportive care; I-O, immuno-oncology agent; PD, platinum doublet chemotherapy


Introduction of these five therapies was estimated to increase the average 1- and 3-year survival of Canadian aNSCLC patients from 69% and 14% to 73% and 21%, respectively. Estimated average lifetime cost per treated patient rose from $159,764 to $269,056. ALK positive patients were estimated to have the largest increase in 3-year survival, from 35% to 64%, and cost of treatment, from $315,333 to $747,859.


New therapies for aNSCLC are likely to increase the survival and average cost of treatment in Canada.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.


AstraZeneca Canada.


P.K. Cheema: Honoraria (self), Advisory / Consultancy: AstraZeneca Canada, BI, BMS, Roche, Pfizer, Novartis, Takeda and Merck,. W.K. Evans: Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: AstraZeneca Canada, AbbVie, Astellas, BMS, Eisai, Lilly, Janssen, Gilead, Takeda, Boehringer Ingelheim, Roche and Celgene. R. Burkes: Honoraria (self), Advisory / Consultancy: AstraZeneca Canada. R. Sangha: Honoraria (self), Advisory / Consultancy: Pfizer, BI, AZ, Roche/Genentech, Lundbeck, BMS, Merck, AbbVie and Takeda, Lilly, BMS, Novartis. C. Ho: Honoraria (self), Advisory / Consultancy, Speaker Bureau / Expert testimony: AstraZeneca Canada, Boehringer Ingelheim, Pfizer, BMS, Roche, Lilly, Genzyme, Eisai, Merck and Bayer. P. Wheatley-Price: Honoraria (self), Advisory / Consultancy, Leadership role: Novartis, BMS, Merck, AZ, Takeda, Roche and AbbVie. D. Boehm: Honoraria (self): AstraZeneca Canada, Baxter and Genomic Health. J. Venkatesh: Honoraria (self): AstraZeneca Canada, Takeda. S. Walisser: Honoraria (self), Advisory / Consultancy: stellas Pharma Canada, AstraZeneca Canada, Gilead Sciences Canada, Pfizer, and Janssen Inc. D. Grima: Shareholder / Stockholder / Stock options, Full / Part-time employment, Officer / Board of Directors: Cornerstone Research Group. D. Moldaver: Full / Part-time employment: Cornerstone Research Group. M. Hurry: Full / Part-time employment: AstraZeneca Canada.

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