Budget impact analysis of neoadjuvant nivolumab for non-small cell lung cancer in the Chilean public healthcare system: An exploratory economic assessment.

IF 2.8 3区医学 Q2 ONCOLOGY

Clinical & Translational Oncology Pub Date : 2025-03-02 DOI:10.1007/s12094-025-03872-7

Daniela Paredes-Fernández, Rony Lenz-Alcayaga, Francisco Orlandi-Jorquera

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引用次数: 0

Abstract

Purpose: Effective and sustainable treatments to improve patient outcomes are urgently needed for non-small cell lung carcinoma (NSCLC). Neoadjuvant therapies, particularly nivolumab, have shown superior outcomes in event-free survival and pathological response, yet financial coverage is scarce. We aim to provide an exploratory economic analysis to assess the implications of its incorporation into routine clinical practice.

Methods: We conducted a six-step BIA (budget impact analysis) based on a decision tree model for pathways, probabilities, and resource utilization from the national payer perspective at an event-free survival (EFS) horizon. We estimated the direct cost of drugs and all healthcare-related services for two scenarios: a baseline scenario [neoadjuvant chemotherapy (CT)] and an alternative scenario [neoadjuvant nivolumab combined with chemotherapy (N + CT)].

Results: The funnel-down technique determined 359 eligible patients nationwide per year. The total cost of treatment in the baseline scenario amounts to CLP $ 7315 million Chilean pesos (€ 8,063,219) per cohort, with three top cost drivers: 1L drugs after recurrence (51.98%), resection (29.33%) and 2L nivolumab (5.85%). The alternative scenario amounted to CLP $ 6853 million (€ 7,553,572), with the highest relative expenditure attributed to the N + CT scheme (61.76%), resection (31.31%), and follow-up (2.73%). Adjuvant costs decrease to 1.03%, as does the expenditure on 1L (51.98% versus 0.34%) and 2L treatments (5.85% versus 0.18%). Early intervention in NSCLC reduces the budgetary impact by 6.3% (savings of - $ 462 million (€ 509,647) per treated cohort).

Conclusions: Early incorporation of N + CT optimizes healthcare expenditure by providing access to therapies that improve survival rates while reducing the need for costly treatments in advanced stages. This approach represents a dominant strategy.

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新辅助纳武单抗对智利公共医疗系统非小细胞肺癌的预算影响分析：探索性经济评估。

目的：迫切需要有效和持续的治疗来改善非小细胞肺癌（NSCLC）患者的预后。新辅助治疗，特别是纳武单抗，在无事件生存和病理反应方面显示出优越的结果，但财政覆盖很少。我们的目的是提供一个探索性的经济分析，以评估其纳入常规临床实践的影响。方法：基于决策树模型，从无事件生存（EFS）的角度，从国家付款人的角度进行了六步预算影响分析（BIA）。我们估计了两种方案的药物和所有医疗保健相关服务的直接成本：基线方案[新辅助化疗（CT）]和替代方案[新辅助纳武单抗联合化疗（N + CT）]。结果：该技术每年在全国范围内确定359例符合条件的患者。在基线情况下，每个队列的治疗总成本为7.315亿智利比索（8,063,219欧元），其中三个最高成本驱动因素：复发后1L药物（51.98%），切除（29.33%）和2L纳武单抗（5.85%）。替代方案共计6.853亿元（7,553,572欧元），其中N + CT方案的相对支出最高（61.76%），切除术（31.31%）和随访（2.73%）。辅助费用降至1.03%，1L治疗（51.98%对0.34%）和2L治疗（5.85%对0.18%）的费用也降至1.03%。NSCLC早期干预减少了6.3%的预算影响（每个治疗队列节省4.62亿美元（509,647欧元））。结论：早期合并N + CT通过提供提高生存率的治疗途径，同时减少了晚期昂贵治疗的需要，从而优化了医疗保健支出。这种方法代表了一种主导战略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical & Translational Oncology 医学-肿瘤学

CiteScore

6.20

自引率

2.90%

发文量

240

审稿时长

1 months

期刊介绍： Clinical and Translational Oncology is an international journal devoted to fostering interaction between experimental and clinical oncology. It covers all aspects of research on cancer, from the more basic discoveries dealing with both cell and molecular biology of tumour cells, to the most advanced clinical assays of conventional and new drugs. In addition, the journal has a strong commitment to facilitating the transfer of knowledge from the basic laboratory to the clinical practice, with the publication of educational series devoted to closing the gap between molecular and clinical oncologists. Molecular biology of tumours, identification of new targets for cancer therapy, and new technologies for research and treatment of cancer are the major themes covered by the educational series. Full research articles on a broad spectrum of subjects, including the molecular and cellular bases of disease, aetiology, pathophysiology, pathology, epidemiology, clinical features, and the diagnosis, prognosis and treatment of cancer, will be considered for publication.