Abstract：
UNASSIGNED: To estimate in a panel of patients with locally advanced/metastatic nonsquamous non-small cell lung cancer (NSCLC) treated with a programmed death receptor-1 inhibitor in the US in 2024 (1) the cost-efficiency of toripalimab regimens compared to pembrolizumab regimens; and (2) the budget-neutral expanded access to additional toripalimab cycles and regimens from accrued savings.
UNASSIGNED: Simulation modeling of toripalimab + pemetrexed + carboplatin in nonsquamous NSCLC to a similar pembrolizumab regimen in a panel of 49,647 patients; utilizing two cost inputs (wholesale acquisition cost (WAC) at market entry and an estimated ex ante toripalimab price point of 80% of pembrolizumab average sales price (ASP)) plus administration costs over one and two years of treatment with treatment rates from 1%-10%. Scenario analyses with treatment durations equivalent to toripalimab and pembrolizumab trials\' median PFS were also conducted.
UNASSIGNED: In the WAC-based models, toripalimab saves $2,223 per patient per cycle and $40,014 over 1 year of treatment ($77,805 over 2 years). Extrapolated to the 49,647-patient panel, estimated 1-year savings range from $19,865,840 (1% treatment rate) to $198,658,399 (10% rate). Reallocating these savings permits budget-neutral expanded access to an additional 1,753 (1% rate) to 17,533 (10% rate) toripalimab maintenance cycles or to an additional 97 (1% rate) to 972 (10%) full 1-year toripalimab regimens with all agents. Two-year savings range from $38,628,022 (1% rate) to $386,280,221 (10%). Reallocating these efficiencies provides expanded access ranging from 3,409 (1% rate) to 34,093 (10%) additional toripalimab cycles or to 97 to 973 full 2-year regimens. The ex ante ASP model showed similar results as did the scenario analyses but at a lower magnitude than the base case.
UNASSIGNED: Toripalimab generates significant savings that enable budget-neutral funding for up to 17,533 [34,093] additional maintenance cycles over one year [two years] with toripalimab + pemetrexed in nonsquamous NSCLC, or 972 [973] full one-year [two-year] regimens.
An estimated 49,647 patients with advanced or metastatic nonsquamous non-small cell lung cancer (NSCLC) will be treated with a PD-1 inhibitor in the US in 2024. Toripalimab, a PD-1 inhibitor recently approved by the US Food and Drug Administration for the treatment of nasopharyngeal carcinoma, has also been found to be beneficial in patients with nonsquamous NSCLC when used in combination with chemotherapy. We conducted an economic simulation of the costs of toripalimab + pemetrexed + carboplatin versus the costs of a similar regimen with the PD-1 inhibitor pembrolizumab in the treatment of patients with nonsquamous NSCLC. Our simulation models used two US cost inputs for toripalimab: the wholesale acquisition cost or “list price” at market entry and, as no average sales price (ASP) will be available for toripalimab for several quarters, a hypothetical toripalimab price point of 80% of the pembrolizumab ASP. We compared the savings in each scenario when between 1% and 10% of the 49,647 nonsquamous NSCLC patients are treated with the toripalimab regimen. We then evaluated how these savings could be re-allocated, without requiring extra funding, to provide more patients with access to toripalimab treatment on a budget-neutral basis. We found that, if 1% of new cases of advanced/metastatic nonsquamous NSCLC were treated with toripalimab for 1 year, these savings are enough to purchase up to 1,753 additional toripalimab maintenance cycles; or these savings could provide up to an additional 97 patients with full one-year regimens with all agents (toripalimab + chemotherapy). If 10% of new cases were treated with toripalimab for 1 year, the savings are enough to purchase up to 17,533 additional toripalimab maintenance cycles; or these savings could provide up to an additional 972 patients with full one-year regimens with all agents.
UNASSIGNED: Simulation modeling of toripalimab + pemetrexed + carboplatin in nonsquamous NSCLC to a similar pembrolizumab regimen in a panel of 49,647 patients; utilizing two cost inputs (wholesale acquisition cost (WAC) at market entry and an estimated ex ante toripalimab price point of 80% of pembrolizumab average sales price (ASP)) plus administration costs over one and two years of treatment with treatment rates from 1%-10%. Scenario analyses with treatment durations equivalent to toripalimab and pembrolizumab trials\' median PFS were also conducted.
UNASSIGNED: In the WAC-based models, toripalimab saves $2,223 per patient per cycle and $40,014 over 1 year of treatment ($77,805 over 2 years). Extrapolated to the 49,647-patient panel, estimated 1-year savings range from $19,865,840 (1% treatment rate) to $198,658,399 (10% rate). Reallocating these savings permits budget-neutral expanded access to an additional 1,753 (1% rate) to 17,533 (10% rate) toripalimab maintenance cycles or to an additional 97 (1% rate) to 972 (10%) full 1-year toripalimab regimens with all agents. Two-year savings range from $38,628,022 (1% rate) to $386,280,221 (10%). Reallocating these efficiencies provides expanded access ranging from 3,409 (1% rate) to 34,093 (10%) additional toripalimab cycles or to 97 to 973 full 2-year regimens. The ex ante ASP model showed similar results as did the scenario analyses but at a lower magnitude than the base case.
UNASSIGNED: Toripalimab generates significant savings that enable budget-neutral funding for up to 17,533 [34,093] additional maintenance cycles over one year [two years] with toripalimab + pemetrexed in nonsquamous NSCLC, or 972 [973] full one-year [two-year] regimens.
An estimated 49,647 patients with advanced or metastatic nonsquamous non-small cell lung cancer (NSCLC) will be treated with a PD-1 inhibitor in the US in 2024. Toripalimab, a PD-1 inhibitor recently approved by the US Food and Drug Administration for the treatment of nasopharyngeal carcinoma, has also been found to be beneficial in patients with nonsquamous NSCLC when used in combination with chemotherapy. We conducted an economic simulation of the costs of toripalimab + pemetrexed + carboplatin versus the costs of a similar regimen with the PD-1 inhibitor pembrolizumab in the treatment of patients with nonsquamous NSCLC. Our simulation models used two US cost inputs for toripalimab: the wholesale acquisition cost or “list price” at market entry and, as no average sales price (ASP) will be available for toripalimab for several quarters, a hypothetical toripalimab price point of 80% of the pembrolizumab ASP. We compared the savings in each scenario when between 1% and 10% of the 49,647 nonsquamous NSCLC patients are treated with the toripalimab regimen. We then evaluated how these savings could be re-allocated, without requiring extra funding, to provide more patients with access to toripalimab treatment on a budget-neutral basis. We found that, if 1% of new cases of advanced/metastatic nonsquamous NSCLC were treated with toripalimab for 1 year, these savings are enough to purchase up to 1,753 additional toripalimab maintenance cycles; or these savings could provide up to an additional 97 patients with full one-year regimens with all agents (toripalimab + chemotherapy). If 10% of new cases were treated with toripalimab for 1 year, the savings are enough to purchase up to 17,533 additional toripalimab maintenance cycles; or these savings could provide up to an additional 972 patients with full one-year regimens with all agents.
摘要：
■评估2024年在美国接受程序性死亡受体-1抑制剂治疗的局部晚期/转移性非鳞状非小细胞肺癌（NSCLC）患者组中（1）与pembrolizumab方案相比，toripalimab方案的成本效益；（2）预算中立的人从累积的储蓄中扩大了对其他toripalimab周期和方案的访问。
■在49,647名患者中，托里帕利马单抗+培美曲塞+卡铂在非鳞状细胞肺癌中与类似的帕博利珠单抗方案的模拟建模；利用两个成本输入（进入市场时的批发获取成本（WAC）和估计的事前托里帕利马价格点为80％的帕博利珠单抗平均销售价格（ASP），加上两年以上的治疗还进行了治疗持续时间相当于托里帕利马和派姆单抗试验的中位PFS的情景分析。
■在基于WAC的模型中，toripalimab每个周期为每位患者节省了2,223美元，在1年的治疗中节省了40,014美元（在2年内节省了77,805美元）。推断到49,647名患者的小组，估计一年的节省从19,865,840美元(1%的治疗率)到198,658,399美元(10%的治疗率)不等。重新分配这些节省允许预算中立地扩大使用额外的1,753（1％的比率）至17,533（10％的比率）托里帕利玛维护周期，或额外的97（1％的比率）至972（10％）完整的1年托里帕利玛治疗方案。两年的节省从38,628,022美元（1%利率）到386,280,221美元（10%）不等。重新分配这些效率可提供从3,409（1％的比率）到34,093（10％）的额外toripalimab周期或97到973个完整的2年方案的扩展访问。事前ASP模型显示出与情景分析相似的结果，但幅度低于基本情况。
■托里帕利马在非鳞状非小细胞肺癌中使用托里帕利马+培美曲塞，可在一年[两年]内节省高达17,533[34,093]个额外的维持周期的预算资金，或972[973]完整的一年[两年]方案。
估计有49,647名晚期或转移性非鳞状非小细胞肺癌（NSCLC）患者将于2024年在美国接受PD-1抑制剂治疗。托里帕利马,一种最近被美国食品和药物管理局批准用于治疗鼻咽癌的PD-1抑制剂，还发现，当与化疗联合使用时，对非鳞状NSCLC患者有益。我们对托里帕利马+培美曲塞+卡铂的成本与PD-1抑制剂派姆单抗治疗非鳞状NSCLC患者的类似方案的成本进行了经济模拟。我们的模拟模型对toripalimab使用了两个美国成本输入：批发采购成本或进入市场时的“标价”，由于toripalimab在几个季度内没有平均销售价格(ASP)，假设toripalimab的价格点为80%的pembrolizumabASP。我们比较了49,647例非鳞NSCLC患者中1％至10％接受toripalimab方案治疗的每种情况下的节省。然后我们评估了如何重新分配这些储蓄，不需要额外的资金，在预算中立的基础上，为更多患者提供接受托里帕利玛治疗的机会。我们发现,如果1％的晚期/转移性非鳞状细胞肺癌新病例接受托利帕利单抗治疗1年，这些节省足以购买多达1,753个额外的托里帕利玛维持周期;或者这些节省可以为多达97名患者提供所有药物(托里帕利玛+化疗)的完整1年方案.如果10％的新病例使用toripalimab治疗1年，节省的费用足以购买多达17,533个额外的托里帕利玛维持周期;或者这些节省的费用可以为多达972名患者提供所有药物的完整1年治疗方案.
■在49,647名患者中，托里帕利马单抗+培美曲塞+卡铂在非鳞状细胞肺癌中与类似的帕博利珠单抗方案的模拟建模；利用两个成本输入（进入市场时的批发获取成本（WAC）和估计的事前托里帕利马价格点为80％的帕博利珠单抗平均销售价格（ASP），加上两年以上的治疗还进行了治疗持续时间相当于托里帕利马和派姆单抗试验的中位PFS的情景分析。
■在基于WAC的模型中，toripalimab每个周期为每位患者节省了2,223美元，在1年的治疗中节省了40,014美元（在2年内节省了77,805美元）。推断到49,647名患者的小组，估计一年的节省从19,865,840美元(1%的治疗率)到198,658,399美元(10%的治疗率)不等。重新分配这些节省允许预算中立地扩大使用额外的1,753（1％的比率）至17,533（10％的比率）托里帕利玛维护周期，或额外的97（1％的比率）至972（10％）完整的1年托里帕利玛治疗方案。两年的节省从38,628,022美元（1%利率）到386,280,221美元（10%）不等。重新分配这些效率可提供从3,409（1％的比率）到34,093（10％）的额外toripalimab周期或97到973个完整的2年方案的扩展访问。事前ASP模型显示出与情景分析相似的结果，但幅度低于基本情况。
■托里帕利马在非鳞状非小细胞肺癌中使用托里帕利马+培美曲塞，可在一年[两年]内节省高达17,533[34,093]个额外的维持周期的预算资金，或972[973]完整的一年[两年]方案。
估计有49,647名晚期或转移性非鳞状非小细胞肺癌（NSCLC）患者将于2024年在美国接受PD-1抑制剂治疗。托里帕利马,一种最近被美国食品和药物管理局批准用于治疗鼻咽癌的PD-1抑制剂，还发现，当与化疗联合使用时，对非鳞状NSCLC患者有益。我们对托里帕利马+培美曲塞+卡铂的成本与PD-1抑制剂派姆单抗治疗非鳞状NSCLC患者的类似方案的成本进行了经济模拟。我们的模拟模型对toripalimab使用了两个美国成本输入：批发采购成本或进入市场时的“标价”，由于toripalimab在几个季度内没有平均销售价格(ASP)，假设toripalimab的价格点为80%的pembrolizumabASP。我们比较了49,647例非鳞NSCLC患者中1％至10％接受toripalimab方案治疗的每种情况下的节省。然后我们评估了如何重新分配这些储蓄，不需要额外的资金，在预算中立的基础上，为更多患者提供接受托里帕利玛治疗的机会。我们发现,如果1％的晚期/转移性非鳞状细胞肺癌新病例接受托利帕利单抗治疗1年，这些节省足以购买多达1,753个额外的托里帕利玛维持周期;或者这些节省可以为多达97名患者提供所有药物(托里帕利玛+化疗)的完整1年方案.如果10％的新病例使用toripalimab治疗1年，节省的费用足以购买多达17,533个额外的托里帕利玛维持周期;或者这些节省的费用可以为多达972名患者提供所有药物的完整1年治疗方案.
