Presentation (CTI)

OBJECTIVES: Although the clinical efficacy of immune checkpoint inhibitors (ICIs) in first-line Extended Stage Small Cell Lung Cancer (ES-SCLC) is well-established, the implications of different administration routes (subcutaneous [SC] and intravenous [IV]) warrant deeper investigation. Within a Health Technology Assessment (HTA) framework, this study evaluates how this formulation characteristics impact economic and organizational dimensions, modelling scenarios to enhance sustainability, efficiency, and patient access.
METHODS: A Budget Impact Analysis (BIA) assessed the economic and organizational consequences of various ICIs in ES-SCLC from the Italian National Healthcare Service (NHS) perspective. Patient setting, preparation and administration times were extracted from Summary of Product Characteristics (SmPC), utilizing dosing schedules from registrative clinical trials (RCTs). Drug acquisition costs for atezolizumab, durvalumab and serplulimab were retrieved from the Italian Official Gazettes, while preparation, administration and consumables expenses were sourced from published literature.
RESULTS: Under an equal-distribution baseline scenario, the mean monthly cost is approximately €8,563 per patient, with an average monthly preparation and administration time of 71.5 minutes. Univariate analysis revealed that exclusive use of IV atezolizumab (1200mg) or SC atezolizumab (1875mg) generates comparable financial savings (-13.2% vs. -11.0%, respectively). SC formulation uniquely enhances allocative efficiency reducing total administration time by 61.5%, whereas IV formulation increases it by at least 1.4%. In scenario analyses targeted at 10% cost reduction and 30% efficiency gain, SC atezolizumab emerged as the primary driver optimizing both expenditures and time.
CONCLUSIONS: Incorporating organizational impact into economic assessments is vital for sustainable innovation in oncology. Subcutaneous immunotherapies serve as a crucial innovation for the Italian NHS to potential lower hospital organizational burdens, secure budget sustainability, and optimize system capacity alongside patient access in ES-SCLC.