EARLY ECONOMIC EVALUATION OF BLOOD-BRAIN BARRIER MODULATION ACROSS LUNG CANCER BRAIN METASTASIS TREATMENT PATHWAYS IN THE UK NHS
Author(s)
Ankur Singh Chauhan, MPH, MSc, PhD1, Nicola R. Sibson, PhD2, Sandra Campbell, PhD2, Simon Lord, PhD2, James Rose, BSc, PhD1, Mamta Bajre, MSc1.
1Health Innovation Oxford and Thames Valley, Oxford, United Kingdom, 2Department of Oncology, University of Oxford, Oxford, United Kingdom.
1Health Innovation Oxford and Thames Valley, Oxford, United Kingdom, 2Department of Oncology, University of Oxford, Oxford, United Kingdom.
OBJECTIVES: Lung cancer accounts for nearly half of all brain metastases, and lung cancer brain metastases (LCBM) have poor prognosis and limited intracranial drug delivery because of the blood-brain barrier. This early-stage economic evaluation assessed the cost-effectiveness of adding mutant tumour necrosis factor (mutTNF), a selective blood-brain-barrier permeabilising adjunct, to standard NHS LCBM pathways.
METHODS: A decision-tree model estimated 1-year costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and net monetary benefit from an NHS perspective. Standard management was compared with standard management plus mutTNF across systemic therapy alone, systemic therapy plus surgery, and systemic therapy plus radiotherapy pathways. Inputs were derived from published literature, NICE appraisals, NHS reference costs, BNF prices, preclinical and translational evidence. Deterministic base-case, subgroup, scenario, price-threshold, probabilistic sensitivity analysis (PSA; 100,000 Monte Carlo simulations), and expected value of perfect information (EVPI) analyses were conducted at GBP30,000/QALY.
RESULTS: In the base case, standard management cost GBP47,330 and generated 0.685 QALYs, while standard management plus mutTNF cost GBP47,346 and generated 0.745 QALYs. Incremental cost was GBP16 and incremental effectiveness was 0.061 QALYs, producing an ICER of GBP268/QALY. Subgroup analyses demonstrated consistent cost-effectiveness across treatment pathways, with ICERs remaining below GBP3,000/QALY. Scenario analysis showed cost-effectiveness with a smaller assumed benefit (+0.03 QALYs; ICER GBP532/QALY). mutTNF remained cost-effective up to GBP1,834 per dose. In PSA, mutTNF generated higher net monetary benefit than standard management and was cost-effective in 70.9% of simulations. EVPI was GBP603 per patient.
CONCLUSIONS: Under the model assumptions and available preclinical evidence, adding mutTNF to standard LCBM management was associated with improved QALYs, minimal incremental costs, and favourable cost-effectiveness across pathways. The findings were robust across scenario, subgroup, and probabilistic analyses, with low decision uncertainty in value-of-information analysis. Prospective studies are needed to validate intracranial benefit, further characterise the role of mutTNF within NHS LCBM pathways, and inform NHS decision-making
METHODS: A decision-tree model estimated 1-year costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and net monetary benefit from an NHS perspective. Standard management was compared with standard management plus mutTNF across systemic therapy alone, systemic therapy plus surgery, and systemic therapy plus radiotherapy pathways. Inputs were derived from published literature, NICE appraisals, NHS reference costs, BNF prices, preclinical and translational evidence. Deterministic base-case, subgroup, scenario, price-threshold, probabilistic sensitivity analysis (PSA; 100,000 Monte Carlo simulations), and expected value of perfect information (EVPI) analyses were conducted at GBP30,000/QALY.
RESULTS: In the base case, standard management cost GBP47,330 and generated 0.685 QALYs, while standard management plus mutTNF cost GBP47,346 and generated 0.745 QALYs. Incremental cost was GBP16 and incremental effectiveness was 0.061 QALYs, producing an ICER of GBP268/QALY. Subgroup analyses demonstrated consistent cost-effectiveness across treatment pathways, with ICERs remaining below GBP3,000/QALY. Scenario analysis showed cost-effectiveness with a smaller assumed benefit (+0.03 QALYs; ICER GBP532/QALY). mutTNF remained cost-effective up to GBP1,834 per dose. In PSA, mutTNF generated higher net monetary benefit than standard management and was cost-effective in 70.9% of simulations. EVPI was GBP603 per patient.
CONCLUSIONS: Under the model assumptions and available preclinical evidence, adding mutTNF to standard LCBM management was associated with improved QALYs, minimal incremental costs, and favourable cost-effectiveness across pathways. The findings were robust across scenario, subgroup, and probabilistic analyses, with low decision uncertainty in value-of-information analysis. Prospective studies are needed to validate intracranial benefit, further characterise the role of mutTNF within NHS LCBM pathways, and inform NHS decision-making
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE389
Topic
Clinical Outcomes, Economic Evaluation, Methodological & Statistical Research
Topic Subcategory
Value of Information
Disease
Genetic, Regenerative & Curative Therapies, Oncology, Personalized & Precision Medicine