Comparing Costs of Immune Checkpoint Inhibitors for Treatment of 1L NSCLC in Colombia – A Cost Minimisation Analysis

OBJECTIVES:

The Cuenta de Alto Costo estimated 2020 lung cancer prevalence and mortality in Colombia at 8.96 and 2.93 per 100.000, respectively. Non-small-cell lung cancer (NSCLC) accounts for 84% of cases and is associated with short life expectancy. The recent introduction of immune checkpoint inhibitors (ICI) has substantially improved prognosis for patients with advanced NSCLC. In the first-line (1L) setting, these ICIs include nivolumab plus ipilimumab plus chemotherapy (NIVO+IPI+PDC; CheckMate-9LA; regardless of histology or PD-L1) atezolizumab with chemotherapy plus bevacizumab (IMpower150; non-squamous), pembrolizumab monotherapy (KEYNOTE-024; PD-L1>50%), and two regimens combining pembrolizumab and chemotherapy (KEYNOTE-189; non-squamous and KEYNOTE-407; squamous). This study aimed to evaluate total costs of available ICI therapies for treatment of patients with untreated stage IV or recurrent NSCLC in Colombia.

METHODS:

In absence of formal assessment by the Colombian HTA agency (IETS), the analysis was conducted in accordance with published outcomes by HTA bodies in Sweden and The Netherlands. These agencies assumed that the various ICIs have similar efficacy and that a cost-minimisation analysis was thus an appropriate method. Official drug prices were obtained from regulation list prices issued by the Colombian government. Duration of therapy and progression-free survival data (as a proxy) from CheckMate-9LA were used to inform drug acquisition costs for NIVO+IPI+PDC and other regimens, respectively. Treatment-specific costs for drug administration, monitoring, management of adverse events, and 2L treatments were also included. The analysis was conducted from payer perspective using a 2-year time horizon.

RESULTS:

Total cost for treatment of a patient with advanced NSCLC with the CheckMate-9LA, KEYNOTE-024 and KEYNOTE-407 regimens were ranging between 390-400M COL$, 417M COL$ for the IMpower150 and 506M COL$ for the KEYNOTE-189 regimen.

CONCLUSIONS:

ICIs provide new first-line treatment options and improve overall survival for patients with advanced NSCLC. This study provides a perspective on estimated total treatment costs for ICI regimens in Colombia.