Presentation (CTI)

OBJECTIVES: To estimate the projected budget impact of introducing a hypothetical oral small molecule PD-L1 inhibitor compared with standard IV pembrolizumab for first-line treatment of metastatic NSCLC from a US commercial payer perspective.
METHODS: A budget impact model was developed from a US commercial payer perspective over a 1-year time horizon. The eligible population included adult patients with metastatic NSCLC with PD-L1 tumor proportion score ≥1% and without EGFR or ALK genomic alterations. Two scenarios were evaluated: (1) a current scenario with 100% utilization of IV pembrolizumab (200 mg every 3 weeks), and (2) a future scenario introducing an oral small-molecule PD-L1 inhibitor with a modeled 10% market uptake. Costs included drug acquisition based on published 2025 pricing benchmarks and administration costs associated with IV therapy, which were excluded for the oral alternative. For economic modeling purposes, the oral therapy was assumed to be administered as continuous twice-daily dosing to reflect conservative exposure assumptions.
RESULTS: For a hypothetical health plan with 1,000,000 covered lives and an estimated 50 eligible patients annually, total annual costs under the IV-only scenario were modeled at approximately $9.68 million ($193,500 per patient). Under the future scenario, the modeled oral PD-L1 inhibitor—priced at 60% of IV biologic therapy—was associated with a lower per-patient annual cost of $72,800. Switching 10% of patients (n=5) to the oral therapy resulted in projected annual savings of $603,500 for the payer. Modeled savings were primarily driven by reduced drug acquisition costs and elimination of infusion-related administration expenses.
CONCLUSIONS: The modeled introduction of oral small-molecule PD-L1 inhibitors may represent a potential cost-containment opportunity for US payers managing metastatic NSCLC. This budget impact analysis suggests that future oral immunotherapy options could reduce overall treatment costs by lowering acquisition and administration expenditures. These findings may support payer preparedness and economic planning for emerging immuno-oncology therapies, pending clinical validation.