Presentation (CTI)

OBJECTIVES: Non-small cell lung cancer (NSCLC) is associated with substantial clinical and societal burden in Bulgaria, largely due to diagnosis at advanced stages. Earlier diagnosis may allow treatment initiation before metastatic progression, when long-term health gains are expected to be greater. This study estimated the health and socioeconomic value of innovative immunotherapy and targeted therapy for NSCLC across adjuvant/neoadjuvant, first-line metastatic, and second-line metastatic treatment settings in Bulgaria.
METHODS: A health-economic model with a lifetime horizon estimated health gains from innovative therapies, expressed as quality-adjusted life years (QALYs). An annual discount rate of 3.5% was applied, and only discounted outcomes were reported. The analysis included patients treated in the adjuvant/neoadjuvant, first-line metastatic, and second-line metastatic settings. QALYs were estimated per patient and for the total treated population in each setting. Economic contribution was estimated by translating health gains into gross domestic product (GDP) contribution for working-age patients.
RESULTS: The analysis included 2,217 treated patients with NSCLC: 131 in the adjuvant/neoadjuvant setting, 1,757 receiving first-line metastatic treatment, and 329 receiving second-line metastatic treatment. Discounted QALYs per patient were highest in the adjuvant/neoadjuvant setting, reaching 7.44, compared with 3.23 in first-line metastatic disease and 1.57 in second-line metastatic disease. Overall, treatment generated 974.06 discounted QALYs in the adjuvant/neoadjuvant setting, 5,671.45 in first-line metastatic disease, and 517.20 in second-line metastatic disease. Across the total treated population, this corresponded to 7,162.71 discounted QALYs and an estimated GDP contribution of EUR 59,520,967.72 among working-age patients.
CONCLUSIONS: The greatest value of innovative therapies in NSCLC is achieved when patients are diagnosed before metastatic progression and treated in earlier disease stages. Timely access to personalized treatments should remain a national priority to improve outcomes and support societal and economic sustainability.