PMID- 37250095 OWN - NLM STAT- MEDLINE DCOM- 20230601 LR - 20230602 IS - 2296-2565 (Electronic) IS - 2296-2565 (Linking) VI - 11 DP - 2023 TI - Health outcomes and budget impact projection of anti-PD-(L)1s in cancer care in Portugal. PG - 1133959 LID - 10.3389/fpubh.2023.1133959 [doi] LID - 1133959 AB - INTRODUCTION: PD-[L]1 inhibitors revolutionized cancer treatment but challenge the affordability of health systems. This policy-focused model aimed to estimate the health and budget impact of anti-PD-(L)1s in Portugal and inform current discussions. MATERIALS AND METHODS: The Health Impact Projection (HIP) model estimates clinical (life years, progression-free survival [PFS] years, and quality-adjusted life years [QALY] gained and adverse events [AEs] incurred) and economic (direct and indirect costs) outcomes in a world where cancer patients are initiating treatment with standard-of-care (SOC) versus SOC plus anti-PD-(L)1s over a 3-year time horizon. Indications included adjuvant and metastatic melanoma, non-small cell lung cancer (first and second line), metastatic triple-negative breast cancer, head and neck cancer, urothelial carcinoma, and renal cell carcinoma. Model inputs were based on publicly available literature data and expert opinion. RESULTS: The model estimated that, over 3 years, 7,773 patients would be treated with anti-PD-(L)1s, realizing a gain of 4,787 life years, 6,901 PFS years, and 4,214 QALYs and avoiding 399 AEs. The introduction of anti-PD-(L)1s had a projected average annual impact of approximately euro108 million and a share of 20% of total cancer medicines expenditure and 0.6% of total healthcare expenditure in 2021. Although higher disease management costs are expected for patients living longer with anti-PD-(L)1s and drug acquisition costs are considerable, that is partially offset by a reduction in end-of-life costs (euro611,092/year) and costs associated with patient productivity lost to cancer (euro9,128,142/year). DISCUSSION: This model highlights the significant survival and QoL benefit of anti-PD-(L)1s for cancer patients in Portugal, with a relatively low increased cost in total healthcare expenditure. CI - Copyright (c) 2023 Costa, Alexandre, Mansinho, Sousa, Vieira, Hughes, Roediger, Pereira and Araujo. FAU - Costa, Luis AU - Costa L AD - Department of Oncology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal. AD - Instituto de Medicina Molecular-Joao Lobo Antunes, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal. FAU - Alexandre, Teresa AU - Alexandre T AD - Department of Medical Oncology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, E. P. E, Lisbon, Portugal. FAU - Mansinho, Andre AU - Mansinho A AD - Department of Oncology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal. FAU - Sousa, Rita AU - Sousa R AD - Department of Oncology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal. FAU - Vieira, Claudia AU - Vieira C AD - Department of Medical Oncology, Instituto Portugues de Oncologia do Porto Francisco Gentil, Porto, Portugal. FAU - Hughes, Robert AU - Hughes R AD - Adelphi Values PROVE, Bollington, United Kingdom. FAU - Roediger, Alexander AU - Roediger A AD - MSD International GmbH, Kriens, Switzerland. FAU - Pereira, Sonia Matos AU - Pereira SM AD - MSD Portugal, Paco de Arcos, Portugal. FAU - Araujo, Antonio AU - Araujo A AD - Department of Medical Oncology, Centro Hospitalar Universitario Santo Antonio, Porto, Portugal. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230512 PL - Switzerland TA - Front Public Health JT - Frontiers in public health JID - 101616579 SB - IM MH - Humans MH - *Carcinoma, Non-Small-Cell Lung/drug therapy MH - *Lung Neoplasms/drug therapy MH - *Carcinoma, Transitional Cell MH - Portugal MH - Quality of Life MH - *Urinary Bladder Neoplasms MH - Cost-Benefit Analysis MH - Outcome Assessment, Health Care PMC - PMC10215539 OTO - NOTNLM OT - Portugal OT - anti-PD-(L)1 OT - budget OT - cancer care OT - clinical impact COIS- LC participated in advisory boards sponsored by MSD. AM received honoraria as consultant/speaker from Amgen, Astellas, Bayer, B. Braun, Bristol Myers-Squibb, Janssen, Merck-Serono, Merck Sharp & Dohme, Novartis, OM Pharma, Pfizer, Pierre Fabre, Roche, and Servier; travel/logistics support from Amgen, Astellas, Bayer, Bristol Myers-Squibb, Janssen, Merck-Serono, Merck Sharp & Dohme, Novartis, OM Pharma, Pfizer, Pierre Fabre, Roche, and Servier; and research funding from Bayer. RS received honoraria as consultant/speaker from Roche, Merck Sharp & Dohme, Novartis, Pierre-Fabre, Bristol-Myers Squibb, Astrazeneca, Glaxosmith, Lilly, Pfizer, and Tesaro. CV performed consulting or advisory activities for MSD, Bristol-Myers Squibb, Merck Serono, Novartis, F. Hoffmann-La Roche Ltd., Lilly and Grunenthal and received reimbursement for travel expenses from F. Hoffmann-La Roche Ltd., MSD, BMS, Pfizer, and Novartis. RH is an employee of Adelphi Values Ltd. Adelphi Values Ltd. received reimbursement from MSD for the conduct of this study. AR and SP are employees of MSD and may own stock and/or hold stock options in Merck & Co., Inc., Kenilworth, NJ, USA. AA performed consulting/advisory activities for Merck Sharp & Dohme, Bristol Myers Squibb, AstraZeneca, Janssen, Pfizer, IPSEN, Takeda, Boehringer Ingelheim; research funding for Astellas, Janssen; and expert testimony for Merck Sharp & Dohme, Bristol Myers Squibb, AstraZeneca, Janssen, Pfizer, IPSEN, Takeda, and Boehringer Ingelheim. The authors declare that this study received funding from MSD Portugal and MSD International Business GmbH. The funder had the following involvement in the study: funding in model development, contributing with local data and expertise, and commenting on the paper. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. EDAT- 2023/05/30 13:07 MHDA- 2023/06/01 06:42 PMCR- 2023/05/12 CRDT- 2023/05/30 11:19 PHST- 2022/12/29 00:00 [received] PHST- 2023/04/07 00:00 [accepted] PHST- 2023/06/01 06:42 [medline] PHST- 2023/05/30 13:07 [pubmed] PHST- 2023/05/30 11:19 [entrez] PHST- 2023/05/12 00:00 [pmc-release] AID - 10.3389/fpubh.2023.1133959 [doi] PST - epublish SO - Front Public Health. 2023 May 12;11:1133959. doi: 10.3389/fpubh.2023.1133959. eCollection 2023.