Comparison Between Drug Costs for the Systemic Treatment of Metastatic Lung Cancer, Overall Survival Gain and Economic Growth in Brazil

Abstract only Background: Systemic treatment of patients with metastatic lung cancer is considered a major advancement in the field of oncology. Although undeniable progress has been made in the treatment of such patients, affordability of the more recently implemented treatments, for people in the less developed parts of the world has been questioned. Aim: To expose the disparity between cancer drugs costs, survival gain and economic growth in a developing country (Brazil), using first line therapy to metastatic lung cancer (nonsquamous only without driver mutations) as an example. Methods: First we analyzed the costs of all included first-line systemic therapy regimens from NCCN guidelines for metastatic lung cancer (nonsquamous and no driver mutation identified) over the last two decades, dividing the therapy in five broad categories, each one corresponding to a “generation” of treatment. The following regimens were considered: single-agent chemotherapy (cisplatin), first-generation platinum doublet (cisplatin/carboplatin + etoposide), second-generation platinum doublet (cisplatin/carboplatin + vinorelbine/gemcitabine/docetaxel/paclitaxel), third-generation platinum doublet (cisplatin/carboplatin + pemetrexed) and immunotherapy (pembrolizumab). After that, we identified in the pivotal studies, how much median overall survival cumulative gain was obtained in each generation of treatment in comparison with the last one. Then we compiled the data and compared, in graphics, with economic metrics observed for Brazil during the same period, such as nominal gross domestic product (GDP) growth, GDP per capita and inflation. Results: It was observed that the current choice of first line therapy for metastatic nonsquamous lung cancer, without driver mutation: cisplatin + pemetrexed or immunotherapy (for patients with high PD-L1 expression), now costs more than 130 to 200 times the price of single-agent cisplatin. Median overall survival has been increased from 4-6 months to around 10-12 months (all patients considered) or 30 months (for patients with high PD-L1 expression), with small incremental gains for each generation of treatment. In comparison, Brazilian GDP had an increase of 85% during the same time span, while GDP per capita increased 45%. Conclusion: The exponential rising in the price of the drugs surpassed much of the economic growth of Brazil in the last two decades. Although the observed median overall survival has been steadily increasing during th