Presentation (CTI)

OBJECTIVES: While the clinical efficacy of immune checkpoint inhibitors (ICIs) in first line PD-L1-high non-small cell lung cancer (1L NSCLC) is well-established, variations in administration routes (subcutaneous [SC] and intravenous [IV]) require broader evaluation. This study assesses how these product characteristics could influence economic and organizational dimensions within a Health Technology Assessment (HTA) framework, modeling scenarios to improve sustainability, maximize efficiency, and ensure equitable patient access.
METHODS: A Budget Impact Analysis (BIA) was conducted to evaluate the economic and organizational impact of different ICIs in 1L NSCLC from the Italian National Health Service (NHS) perspective. Patient settings, drug preparation, and administration times were derived from the Summary of Product Characteristics (SmPC), with specific dosing schedules from registrative clinical trials (RCTs). Drug acquisition costs for atezolizumab, pembrolizumab, and cemiplimab were sourced from the Italian Official Gazette, while other direct costs related to preparation, administration and consumables were extracted from published literature.
RESULTS: In a baseline scenario with equal ICIs market distribution, the average monthly cost is approximately €8,649 per patient, with a mean monthly preparation and administration time of 68.0 minutes. Univariate analysis showed that IV atezolizumab (1200mg) and SC atezolizumab (1875mg) yield comparable economic savings (-14.1% vs -11.9%) if used exclusively. However, the SC formulation uniquely improves allocative efficiency by reducing total administration time by 59.5%, whereas the IV formulations increase it by 6.6%. Scenario analyses focusing on a 10% cost reduction and a 30% efficiency gain identified SC atezolizumab as the primary driver of optimized costs and time.
CONCLUSIONS: Integrating organizational impact into economic evaluations is essential for sustainable oncology innovation. BIA identify atezolizumab SC as main driver for both NHS economic sustainability and organizational impact thanks to reduced drug cost, preparation and administration times maximizing therefore system capacity and Italian patient access in 1L NSCLC.