Neoadjuvant and Adjuvant Therapy; Calculating Costs

Background: Neoadjuvant Nivolumab plus chemotherapy improved event-free survival in early resectable lung cancer. The target therapy Osimertinib is used as neoadjuvant, adjuvant and in advanced advanced/metastatic non-small lung cancer (a/m- NSCLC). The current clinical practice in a/m- NSCLC is to continue Osimertinib, if effective and safe. The estimated 3-year cost was $745,116, necessitating placement of $500,000 cap. The median immune check point inhibitors (ICI) 3-year cost of $404,388 was below the cap (Guirgis, ESMED, 2023). We aimed to quantify and compare ICI-and Osimertinib costs in earlier vs advanced stages in multiple solid tumors. Methods: Annual 2019-2020 costs of Osimertinib were calculated ad monthly optimal dose x 12. The ICI were calculated as dose x mg/m2 or per 80 kg x price x number of cycles. Results: The, 2-year Osimertinib cost in 1 st and 2 nd -line metastatic disease was $496,744, adjuvant 1-year $248,372 and neoadjuvant $31,046.