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Health impact of using anti-PD-(L)1 agents to treat early-stage cancers in Switzerland: a modeling study
Andrea Favre-Bulle1, Maja Stanković1, Tyler Mantaian2
1Global Human Health, MSD, Lucerne, Switzerland.
Background:
Inhibitors of programmed cell death protein 1 (PD-1) and its ligand (PD-L1) (referred to hereafter as anti-PD-(L)1 agents) are approved to treat a variety of advanced-stage cancers. Incorporating these agents into neoadjuvant/adjuvant treatment regimens for early-stage cancers may provide health and economic benefits at the population level.
Methods:
A health outcomes projection model compared two scenarios in Switzerland: I) anti-PD-(L)1 agents used only for advanced/metastatic disease, and II) anti-PD-(L)1 agents starting in the neoadjuvant/adjuvant setting. The model focused on three cancers for which anti-PD-(L)1 agents are currently approved in Europe in early stages: melanoma, renal cell carcinoma (RCC), and triple-negative breast cancer (TNBC), projecting clinical evolution over 10 years. Estimated outcomes included life-years, quality-adjusted life-years (QALYs), recurrences/events, active treatments for metastatic disease, adverse events, and deaths.
Results:
Of the estimated 10,659 eligible patients during 2022-2031, 9,050 were predicted to initiate neoadjuvant and/or adjuvant treatment with anti-PD-(L)1 agents for treatment of melanoma, RCC, or TNBC. Compared to anti-PD-(L)1 agents being available only in the metastatic setting, use of anti-PD-(L)1 agents in the neoadjuvant and/or adjuvant setting for these 3 cancers was projected to avoid 1,144 recurrences (a 27% decrease), prevent 1,577 active treatments in the metastatic setting (a 35% decrease), avoid 530 deaths (a 23% decrease), and increase life-years without recurrence by 3,416 (a 10% increase).
Conclusion:
The use of anti-PD(L)1 agents to treat early-stage cancers in Switzerland is anticipated to result in better outcomes by preventing recurrences/events, active metastatic treatments, and deaths.
Insights
Using programmed cell death protein 1 (PD-1) inhibitors in early-stage cancers like melanoma, RCC, and TNBC can significantly improve patient outcomes. This approach is projected to decrease recurrences, metastatic treatments, and deaths, offering substantial health benefits.
Area of Science:
- Oncology
- Immunotherapy
- Health Economics
Background:
- Programmed cell death protein 1 (PD-1) and its ligand (PD-L1) inhibitors (anti-PD-(L)1 agents) are established treatments for advanced cancers.
- Investigating the integration of anti-PD-(L)1 agents into neoadjuvant/adjuvant settings for early-stage cancers may yield significant population-level health and economic advantages.
Purpose of the Study:
- To compare two scenarios in Switzerland regarding the use of anti-PD-(L)1 agents: exclusive use in advanced/metastatic disease versus early introduction in neoadjuvant/adjuvant settings.
- To project the clinical and economic impact of early-stage anti-PD-(L)1 treatment over 10 years for melanoma, renal cell carcinoma (RCC), and triple-negative breast cancer (TNBC).
Main Methods:
- A health outcomes projection model was developed to simulate patient trajectories under two distinct treatment strategies.
- The model focused on melanoma, RCC, and TNBC, analyzing outcomes such as life-years, QALYs, recurrence rates, metastatic treatment needs, adverse events, and mortality.
- Projections covered a 10-year period, estimating outcomes for an eligible patient cohort.
Main Results:
- Implementing anti-PD-(L)1 agents in the neoadjuvant/adjuvant setting for melanoma, RCC, and TNBC is projected to treat approximately 9,050 eligible patients.
- This strategy is expected to reduce recurrences by 27% (1,144 events), decrease metastatic treatments by 35% (1,577 cases), and lower deaths by 23% (530 cases).
- An increase of 3,416 life-years without recurrence (10% improvement) is anticipated compared to using anti-PD-(L)1 agents solely for metastatic disease.
Conclusions:
- The early application of anti-PD-(L)1 agents in treating early-stage cancers in Switzerland is predicted to substantially enhance patient outcomes.
- Key benefits include the prevention of cancer recurrences, a reduction in the need for aggressive metastatic treatments, and a decrease in mortality rates.
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