Presentation (CTI)

OBJECTIVES: Decision-makers often undervalue pharmaceutical innovation, as new treatments tend to offer modest benefits. However, lifetime approaches to assess the benefit of innovation can suggest significant long-term survival improvements. We assessed treatment modalities for non-small cell lung cancer (NSCLC) to demonstrate the incremental value of treatment innovation in the UK.
METHODS: The methodology comprised two distinct phases: First, we identified all medicinal products for NSCLC that received marketing authorisation (MA) from the European Medicines Agency (1995-2024). A literature search and clinician validation allowed characterisation of the drugs into "innovation waves" based on year of approval and treatment technology. NICE technology appraisals were used to establish UK reimbursement status for the identified drugs. Subsequently, we systematically identified the relevant randomised clinical trials used in the MA submissions for the identified products and captured relevant endpoints including overall- and progression free survival and their associated performance, line of therapy and eligible population.
RESULTS: 36 NSCLC products were approved between 1995 and 2024; these were categorised across three innovation ‘waves’: (a) chemotherapy products; (b) targeted therapies for specific NSCLC genetic mutations; (c) immunotherapy products. Preliminary results indicate that chemotherapy dominated treatment before the mid-2000s. Whilst not replacing chemotherapy, successive innovation waves became more targeted as mutations related to NSCLC were identified and investigated from mid-2005 onwards. Examples include drugs for patients with mutations in EGFR and ALK genes such as osimertinib and crizotinib. Immunotherapies like bevacizumab also began to be introduced in the same time period. Drugs in innovation waves two and three tended to be introduced as later line therapies for patients whose previous therapies had failed and offered significant additional survival and quality of life (QoL) benefits.
CONCLUSIONS: Significant technological changes occurred in the past 30 years to advance NSCLC treatment, offering survival and QoL benefits. Decision-makers should adopt a life-time approach to valuing innovation.