Costs and values of nivolumab in second-line cancer.

e20629 Background: Nivolumab (Nivo) has been approved in 2nd-line treatment of melanoma, squamous (sq) and non-sq- non-small cell-lung (NSCLC), renal cell, and sq-cell of head and neck (SCCHC). Our objective was to screen and compare values (V) of Nivo in cancer. Methods: Nivo median overall survival gain over control (OS), hazard ratios (HR), doses and frequency were extracted from previously published clinical trials. Data and prices posted by the parent company were utilized. Probability of survival (PoS) was calculated as (1.0- HR). Costs (C) were computed at 4 week (w), V as 4wC/PoS (4wV) and year-C/life-year gain (C/LYG). Relative values (RV) were expressed as $100,000/C/LYG. Adverse events C were not accounted for. Results: Estimated Nivo 4wC in early 2016 was $10,021. Conclusions:HR- based platform was proposed to screen and compare V of Nivo. At 0.42 HR in melanoma and >150 day-OS in renal cell, the results suggested that Nivo was fairly-priced for its V. In non-enriched non-sq-NSCLC and SCCHN, the PD-L1 enrichment was necessary to enhance V significantly and justify C. [Table: see text]

Costs and values of the immune check point inhibitors antibodies in non-small cell lung cancer.

e20644 Background: Costs (C) and values (V) of the check point inhibitors antibodies have not been compared. Our objectives were to weigh and compare C and V of Nivolumab (Nivo), Atezolizumab (Atezo) and Pembrolizumab (Pembro) vs. Docetaxel (Doc) in 2nd-line non-small-cell lung cancer (NSCLC). Methods: Median overall survival gain over control (OS), hazard ratios (HR), doses and prices posted by parent companies were quoted. Probability of survival (PoS) was calculated as (1.0- HR). Values were computed at 4-week (w) as 4wC/PoS and one-year as C/life-year gain (LYG). Results: Doc OS was 72 days, HR not reported, generic 4wC < $500 and C/LYG 26,896. In comparison, in non-enriched non-squamous (sq-) Nivo C/LYG was 558,313, Atezo 618,244, Pembro 659,059. Nivo OS was 84, HR 0.73, 4wC $10,021 and 4wV 37,115 improving in > 10% PD-L1 positive to OS 264, HR 0.27 and 4wV 13,727. Atezo OS was 87, HR 0.73, 4wC $11,493 and 4wV 42,567 improving in medium- high PD-L1 to 150, 0.46 and 4wV 21,283 respectively. Pembro demonstrated OS 57, HR 0.71, 4wC $8,027 and 4wV 27,679 improving in > 50% PD-L1 to 201, 0.54 and 4wV 17,450. Conclusions: Doc, without accounting for adverse events and quality of life, remains a valuable drug in 2nd-line NSCLC. In PD-L1- enriched non-sq, Nivo, Atezo and Pembro consistently demonstrated marked V improvement to justify their C. The limited available data and the inherent problems of drug comparison preclude favoring one ICPIA over another. References: Doc: Shepherd FA et al. JCO 18:2095, 2000; Nivo: Checkmate 057, Brahmer JN et al. NEJM 373: 123, 2015; Atezo: POPLAR; Pembro: KEYNOTE-010.

Grading methodology for costs and values of anti-cancer drugs; application in metastatic colorectal cancer

<p><strong>Background</strong>: The present study was prompted by the inability of patients to afford the costs and understand value issues of anticancer drugs. We postulated that society in the United States would be willing to pay 4-week costs (4wC) up to $5,000 and reject &gt;$10,000.</p><p><strong> Objectives</strong>: 1- Propose simplified methodology to grade costs, weigh values and apply in metastatic colorectal cancer (mCRC)</p><p><strong>Methods: </strong> 4-week society costs (4wC) were graded A for up to $5,000, B $ &gt;5,000 to $7,500, C $&gt;7,500 to $10,000, D &gt;$10,000. Values defined as C/life-year gain (LYG) were graded from A100,000 to D &gt;300,000. Relative values (RV) were calculated with reference to 100,000 QALY. RV = 100,000/C/LYG for drugs with maintenance or improvement of quality of life (QoL).</p><p><strong>Results:</strong> In 1st-line 4wC and grades of Bevacizumab (Bev) were $4,620/A. In KRAS wild type Paninutumab (Pan) was $8,233/C and Cetuximab (Cet) $9,775/C. Values and grades were Bev 141,549/B, Pan 269,444/B and Cet 351,900/D. The corresponding RV were 0.71, 0.49 and 0.28. In 2^nd-line Ramucirumab (Ram) 4wC were $11,200/D, values 252,200/C and RV 0.20. In refractory disease Regorafenib (Reg) 4wC were $12,500/D, values 321,429/D and deductible $1,250 compared with TAS 102 $12,890/D, values 257,800/C and deductible $1,289. RV could not be ascertained for lack of immature and/or inconclusive QoL data.</p><p><strong>Conclusions: </strong>Methodology to grade drug costs and values was feasible and user-friendly. In 1^st-line mCRC Bev 4wC was affordable with grade A, higher than Pan and Cet. In later lines 4wC of Ram, TAS 102 and Reg were &gt;$10,000 with D rating. Their values could improve with use at earlier lines of therapy.</p><p><span style="font-size: medium;"> </span></p><p><span style="font-family: Times New Roman;"> </span></p><p> </p>

Economic Modeling of Heart Failure Telehealth Programs: When Do They Become Cost Saving?

Telehealth programs for congestive heart failure have been shown to be clinically effective. This study assesses clinical and economic consequences of providing telehealth programs for CHF patients. A Markov model was developed and presented in the context of a home-based telehealth program on CHF. Incremental life expectancy, hospital admissions, and total healthcare costs were examined at periods ranging up to five years. One-way and two-way sensitivity analyses were also conducted on clinical performance parameters. The base case analysis yielded cost savings ranging from$2832 to$5499 and 0.03 to 0.04 life year gain per patient over a 1-year period. Applying telehealth solution to a low-risk cohort with no prior admission history would result in$2502 cost increase per person over the 1-year time frame with 0.01 life year gain. Sensitivity analyses demonstrated that the cost savings were most sensitive to patient risk, baseline cost of hospital admission, and the length-of-stay reduction ratio affected by the telehealth programs. In sum, telehealth programs can be cost saving for intermediate and high risk patients over a 1- to 5-year window. The results suggested the economic viability of telehealth programs for managing CHF patients and illustrated the importance of risk stratification in such programs.