Presentation (CTI)

OBJECTIVES: IDH-mutant low-grade glioma predominantly affects working-age adults, leading to reduced productivity and labour-force participation, driven by the interplay of disease progression, treatment escalation (radiotherapy/chemotherapy; RT/CT), and co-medication (anti-epileptics/steroids). Vorasidenib, the first approved targeted therapy for patients not requiring immediate RT/CT, delays progression, subsequent therapy escalations and reduces seizures. This study quantified the societal (SI) and fiscal impact (FI) of vorasidenib versus active observation (AO) in Germany, considering economic aspects beyond direct healthcare costs.
METHODS: A nine-health-state microsimulation model (28-day cycles, 10-year horizon) was developed from societal/governmental perspectives. Health gains were translated into paid (market-based) and unpaid (domestic) productivity outcomes through changes in labour-force participation, absenteeism, presenteeism, and work impairment. Fiscal consequences included government revenues (taxes and social security contributions) and expenditures (healthcare costs, sick-leave payments, disability pensions, and public transfers), valued using Germany-specific fiscal parameters at a 3% discount rate (€2025). Inputs were sourced from the INDIGO phase 3 trial, targeted reviews, and German statistical sources.
RESULTS: Preliminary results indicate that vorasidenib modifies the disease trajectory compared to AO, prolonging progression-free survival by ~2.42 years over 10 years (data cut-off: March 2023) and, critically, delaying the need for (RT/CT). This postponement of treatment escalation preserves patients’ functional capacity and social participation, generating additional 2,376 productive hours per patient, translating into societal and fiscal benefits of €112,922 (~€11,000/year, 95% CI: €24,373-€200,139) and €118,628 (~€12,000/year; 95% CI: €98,484-€145,032), respectively. At population level, the net SI and FI are €85-210m and €86-216m, respectively. The model is continuously updated to reflect evolving evidence and treatment landscape.
CONCLUSIONS: By modifying the disease course and delaying progression and treatment escalation during working years, vorasidenib delivers substantial clinical, societal and fiscal benefits. While traditional evaluations focus on direct healthcare costs, these findings demonstrate that a broader perspective is required to fully capture the value of disease-modifying therapies in this population.