OBJECTIVES: New targeted options for patients with advanced/metastatic non-small cell lung cancer (NSCLC) with no driver mutations after chemotherapy failure include nintedanib, nivolumab, pembrolizumab and atezolizumab. Our aim is to estimate drug cost savings for the National Health Service (NHS) when selection criteria (clinical characteristics or biomarkers) are included into treatment decision making.

METHODS: Drug costs based on list Ex-factory price (cut-off date: June 2018; official discount plus VAT included). Vial optimization and drug administration costs not included. Mean duration of treatment according to clinical trials. Patient selection criteria are based on clinical characteristics (disease progression within 9 months after start of first-line treatment or after) and biomarkers (PD-L1 expression or not). Sensitivity analyses were conducted to count for potential lower acquisition costs in the Public Health System.

RESULTS: The current cost of a 28 days treatment cycle in patients with advanced/metastatic NSCLC with no driver mutations after chemotherapy failure in Spain is 2.160€ with nintedanib, 6.600€ with pembrolizumab, 6.300€ with nivolumab and 5.500€ with atezolizumab. The estimated treatment cost per patient is 12.100€, 39.900€, 39.100€ and 34.900€ for nintedanib, nivolumab, pembrolizumab and atezolizumab, respectively. The inclusion of selection criteria into prescription decision making translates into an estimated reduction of a -43% and – 31% regarding to clinical characteristics and biomakrers respectively when pat in drug costs in this patient population.

CONCLUSIONS: The cost of treating patients with advanced/metastasic NSCLC with no driver mutations after prior chemotherapy can be up to 3 times higher depending on the drug selected. The selection of treatment based on the patient profile ensures that patients receive the best treatment option available and contributes to a better use of resources.