Notes on ESMO17: Health economics

Clinical Brief – September 25th

ESMO, or the European Society of Medical Oncology Congress, is an annual gathering of cancer experts and patient advocates. Here are some studies from this year’s ESMO that may be of use.

A study led by researchers from Turkey found that over 90% of their patients taking a targeted cancer treatment was also on another prescription med. More than half of these patients had a drug-drug interaction involving their cancer treatment.

Drug-drug interactions happen when one medication interferes with another, often affecting its absorption or metabolism.

Researchers scanned the records of over 260 patients taking a targeted treatment for cancers. Most common cancers were gastrointestinal and kidney cancers (28% and 26%, respectively). Most common targeted treatments were imatinib (Gleevec) and lapatinib (Tykerb/Tyverb; both 22%).

About 95% of patients were taking a targeted treatment plus another prescription med. Drug interactions between a targeted treatment and another prescription med were found in 54% of cases. About 4 times of 10, the drug interaction reduced the amount of cancer med found in the patient’s body, while the opposite happened 3 times of 10.

Abstract #1127P

In a cost-effectiveness model, researchers from Israel found that differences in the durable response rate of immunotherapies can “dramatically” impact the cost-effectiveness of the drug in the eyes of regulators.

Researchers used second-line nivolumab (Opdivo) vs everolimus (Afinitor) in kidney cancer as a test case. In their model, nivolumab carried an incremental cost-effectiveness ratio of about $147k USD per quality-adjusted life year over everolimus.

By adjusting the durable response rate in their model, they saw the incremental cost-effectiveness ratio drop from $87k USD per quality-adjusted life year for a 10% durable response rate; to $48k USD per quality-adjusted life year for a 20% durable response rate.

This is all hypothetical, of course, and durable response rate is used here as a surrogate read out of the “survival curve tail”.

Abstract #1132P

Researchers from the Pitié-Salpêtrière hospital, France, found that the “poor utilization” of nivolumab (Opdivo) costed their hospital €410k in just one and half years.

Between July 2015 to December 2016, researchers looked through the records of 62 patients with lung cancer for cases of “poor utilization”. They considered this to be any off-label use, in patients with a WHO status <2, or those getting over 10 mg/day of corticosteroids.

They found that 3 in 4 patients were treated with nivolumab as they should, but the rest were not. The survival rate for patients getting nivolumab improperly was 53% vs 70% for patients treated “correctly”. The difference was not statistically significant.

The “poor utilization” of nivolumab costed the hospital €410k for a total of €1.6M in expenditures for nivolumab.

Abstract #1128P

Studies have shown that for women with breast cancer, adding palbociclib (Ibrance) to letrozole may improve progression-free survival.

Researchers from the University of Toronto, Canada, found that the chance of adding palbociclib to letrozole being cost effective was only 50/50.

Using data from the PALOMA 1 and 2 trials as well as other sources, the researchers found that for an incremental cost of $162k CAD, adding palbociclib may add about 15 quality-adjusted life months.

If the healthcare system was willing to pay about $4200 CAD per quality-adjusted life months, the chances of adding palbociclib being cost-effective was zero.

If the healthcare system was willing to pay about $12k CAD per quality-adjusted life months, the chances of adding palbociclib being cost-effective was 50%.

Abstract #1116P

For more presentations from #ESMO17, take a look at my hand-curated Twitter moment 🤓.



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