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Low JL, Huang Y, Sooi K, Chan ZY, Yong WP, Lee SC, Goh BC. Real-world assessment of attenuated dosing anti-PD1 therapy as an alternative dosing strategy in a high-income country (as defined by World Bank). Front Oncol 2022; 12:932212. [PMID: 36465401 PMCID: PMC9714462 DOI: 10.3389/fonc.2022.932212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/17/2022] [Indexed: 09/10/2024] Open
Abstract
The rising cost of oncological drugs poses a global challenge to patients, insurers, and policy makers, with the leading drugs worldwide by revenue from immune checkpoint inhibitors (ICIs). Despite its cost, ICI is marked as a paradigm shift, offering the potential of a long-term cure. To reduce cost, an attenuated dose of ICI based on pharmacological principles can be used while maintaining efficacy. This real-world study aims to examine the prescribing patterns, the effect of financial constraints, and the outcomes in non-small cell lung cancer (NSCLC). All patients receiving palliative intent ICI treatment for advanced NSCLC between January 2014 and April 2021 in National University Hospital, Singapore were recruited. Demographics, prescription trends, factors affecting the prescription of attenuated dose ICI (AD ICI) versus standard dose ICI (SD ICI), and the effect of dose on survival outcomes, toxicities, and costs were examined. Two hundred seventy-four received ICI. The majority of them were treated in first-line setting. One hundred sixty-two (59%) of patients received AD ICI, whereas 112 (41%) received SD ICI. Patients who did not have a supplemental private as-charged health insurance plan were more likely to have received AD ICI (OR: 4.53 [2.69-7.61] p < 0.001). There was no difference in progression-free survival (PFS) and overall survival (OS)-adjusted HR 1.07 CI [0.76, 1.50] p = 0.697 and HR 0.95 CI [0.67, 1.34] p = 0.773, respectively, between patients who received AD versus SD ICI. A cost minimization analysis evaluating the degree of cost savings related to drug costs estimated a within study cost saving of USD 7,939,059 over 7 years. Our study provides evidence for AD-ICI as a promising strategy to maximize the number of patients who can be treated with ICI. This has the potential to make significant economic impact and allow more patients to benefit from novel therapies.
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Affiliation(s)
- Jia Li Low
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore, Singapore
| | - Yiqing Huang
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore, Singapore
| | - Kenneth Sooi
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore, Singapore
| | - Zhi Yao Chan
- Department of Pharmacy, National University Hospital, National University Health System, Singapore, Singapore
| | - Wei Peng Yong
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore, Singapore
- Cancer Science Institute (CSI), National University Singapore, Singapore, Singapore
| | - Soo Chin Lee
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore, Singapore
- Cancer Science Institute (CSI), National University Singapore, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Boon Cher Goh
- Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore, Singapore
- Cancer Science Institute (CSI), National University Singapore, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Price trends of reimbursed oncological drugs in Switzerland in 2005-2019: A descriptive analysis. PLoS One 2021; 16:e0259936. [PMID: 34780556 PMCID: PMC8592494 DOI: 10.1371/journal.pone.0259936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022] Open
Abstract
Increasing oncological treatment costs are a major global concern with the risk of entailing two-tiered health care. Among cost determining factors is the price of individual drugs. In recognition of the central role of this factor, we present a comprehensive overview of the development of monthly prices of oncological drugs introduced over the last 15 years in Switzerland. We identified all oncological drugs newly reimbursed by mandatory health insurance in 2005-2019, and searched public repositories for their package prices, indications with approval dates, and treatment regimens for the calculation of (indication-specific) monthly prices. We found 81 products covering 77 different substances (39.5% protein kinase inhibitors, 21.0% monoclonal antibodies). Most indications related to the topography "blood", followed by "lung and thorax" and "digestive tract". From 2005-2009 to 2015-2019, the median monthly product price over all distinct indications of all products decreased by 7.56% (CHF 5,699 [interquartile range 4,483-7,321] to CHF 5,268 [4,19-6,967]), whereas it increased by 73.7% for monoclonal antibodies. In December 2019, six products had monthly prices over CHF 10,000, all approved for hematological or dermatological cancers. Our analysis suggests that individual price developments of oncological drugs are presently not the major driver of rising cancer treatment costs. However, rising launch prices of some new, mostly hematological drugs are of concern and require continued monitoring.
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Broom A, Kenny K, Page A, Cort N, Lipp ES, Tan AC, Ashley DM, Walsh KM, Khasraw M. The Paradoxical Effects of COVID-19 on Cancer Care: Current Context and Potential Lasting Impacts. Clin Cancer Res 2020; 26:5809-5813. [PMID: 32816894 DOI: 10.1158/1078-0432.ccr-20-2989] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/03/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has fundamentally disrupted the practice of oncology, shifting care onto virtual platforms, rearranging the logistics and economics of running a successful clinical practice and research, and in some contexts, redefining what treatments patients with cancer should and can receive. Since the start of the pandemic in early 2020, there has been considerable emphasis placed on the implications for patients with cancer in terms of their vulnerability to the virus and potential exposure in healthcare settings. But little emphasis has been placed on the significant, and potentially enduring, consequences of COVID-19 for how cancer care is delivered. In this article, we outline the importance of a focus on the effects of COVID-19 for oncology practice during and potentially after the pandemic, focusing on key shifts that are already evident, including: the pivot to online consultations, shifts in access to clinical trial and definitions of "essential care," the changing economics of practice, and the potential legacy effects of rapidly implemented changes in cancer care. COVID-19 is reshaping oncology practice, clinical trials, and delivery of cancer care broadly, and these changes might endure well beyond the short- to mid-term of the active pandemic. Therefore, shifts in practice brought about by the pandemic must be accompanied by improved training and awareness, enhanced infrastructure, and evidence-based support if they are to harness the positives and offset the potential negative consequences of the impacts of COVID-19 on cancer care.
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Affiliation(s)
- Alex Broom
- The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Kenny
- The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander Page
- The University of Sydney, Sydney, New South Wales, Australia
| | - Nicole Cort
- Duke University Medical Center, Duke University, Durham, North Carolina
| | - Eric S Lipp
- Duke University Medical Center, Duke University, Durham, North Carolina
| | - Aaron C Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - David M Ashley
- Duke University Medical Center, Duke University, Durham, North Carolina
| | - Kyle M Walsh
- Duke University Medical Center, Duke University, Durham, North Carolina
| | - Mustafa Khasraw
- The University of Sydney, Sydney, New South Wales, Australia. .,Duke University Medical Center, Duke University, Durham, North Carolina
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Vrdoljak E, Bodoky G, Jassem J, Popescu R, Pirker R, Čufer T, Bešlija S, Eniu A, Todorović V, Kopečková K, Kurteva G, Tomašević Z, Sallaku A, Smichkoska S, Bajić Ž, Sikic B. Expenditures on Oncology Drugs and Cancer Mortality-to-Incidence Ratio in Central and Eastern Europe. Oncologist 2018; 24:e30-e37. [PMID: 30181313 DOI: 10.1634/theoncologist.2018-0093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/24/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a steady decline in cancer mortality in Western Europe (WE), but this trend is not so obvious in Central and Eastern Europe (CEE). One of the largest discrepancies between WE and CEE is the level of investment in cancer care. The objective of our analysis was to examine the correlation between mortality-to-incidence (M/I) ratio and expenditures on oncology drugs in CEE and WE. MATERIALS AND METHODS This cross-sectional analysis was done on publicly available data. Data on expenditures for oncology drugs were obtained from QuintilesIMS, and data on M/I ratio from Globocan. The main outcome was mortality-to-incidence ratio, and the primary analysis was performed by Spearman's rank correlation. RESULTS There is a large discrepancy in expenditure on oncology drugs per cancer case between WE and CEE, and within CEE. Average expenditure on oncology drugs per capita as well as per new cancer case was 2.5 times higher in WE than in CEE. Availability of oncology drugs was highest in Germany (100%), relatively similar in WE (average of 91%), but in CEE it ranged from 37% to 86%, with an average of 70%. Annual expenditures on all oncology drugs per new cancer case was significantly negatively correlated with the M/I ratio (Spearman's ρ = -0.90, p < .001). CONCLUSION There is a financial threshold for oncology drugs per cancer case needed to increase survival. Based on significantly lower expenditures for oncology drugs in CEE in comparison with WE, more investment for drugs as well as better, more organized, value- oriented consumption is needed. IMPLICATIONS FOR PRACTICE Cancer is not treated equally successfully in Western Europe (WE) and in Central and Eastern Europe (CEE). This study showed that success in treatment of cancer is associated with the amount of money invested in oncology drugs. CEE countries spend on average 2.5 times less than WE countries for oncology drugs per new cancer case. These findings should be used by health care providers and oncologists struggling for more resources and better, more organized, evidence-based allocation of these resources as well as better oncology outcomes.
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Affiliation(s)
- Eduard Vrdoljak
- Department of Oncology, Clinical Hospital Center Split, School of Medicine, University of Split, Split, Croatia
| | - Gyorgy Bodoky
- Department of Oncology, St László Teaching Hospital, Budapest, Hungary
| | | | - Razvan Popescu
- Department of Medical Oncology, Tumor Center Aarau, Aarau, Switzerland
| | - Robert Pirker
- Department of Medicine I, Medical University of Vienna, Austria
| | | | - Semir Bešlija
- Institute of Oncology, Clinical Center, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Alexandru Eniu
- Department of Breast Tumors, Cancer Institute "Prof. Dr. I. Chiricuta" Cluj-Napoca, Romania
| | - Vladimir Todorović
- Oncology and Radiotherapy Clinic, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Katerina Kopečková
- Department of Oncology, University Hospital Motol, Charles University, Prague, Czech Republic
| | | | - Zorica Tomašević
- Daily Chemotherapy Hospital, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Agim Sallaku
- Oncology Institute, University Hospital Center Mother Teresa, Tirana, Albania
| | - Snezhana Smichkoska
- Institute University Clinic of Radiotherapy and Oncology, Ss. Cyril and Methodius University, Skopje, Macedonia
| | - Žarko Bajić
- Biometrika Healthcare Research, Zagreb, Croatia
| | - Branimir Sikic
- Oncology Division, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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Dhingra K. Cancer drug costs—the case for a thoughtful discussion of a manageable problem. Ann Oncol 2017; 28:1694-1696. [DOI: 10.1093/annonc/mdx135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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