Real-world assessment of attenuated dosing anti-PD1 therapy as an alternative dosing strategy in a high-income country (as defined by World Bank)
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 cos...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.932212/full |
| _version_ | 1811318287254945792 |
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| author | Jia Li Low Yiqing Huang Kenneth Sooi Zhi Yao Chan Wei Peng Yong Wei Peng Yong Soo Chin Lee Soo Chin Lee Soo Chin Lee Boon Cher Goh Boon Cher Goh Boon Cher Goh |
| author_facet | Jia Li Low Yiqing Huang Kenneth Sooi Zhi Yao Chan Wei Peng Yong Wei Peng Yong Soo Chin Lee Soo Chin Lee Soo Chin Lee Boon Cher Goh Boon Cher Goh Boon Cher Goh |
| author_sort | Jia Li Low |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T12:23:02Z |
| format | Article |
| id | doaj.art-0dd5ed50793047ff8ca7f044e506b976 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-13T12:23:02Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-0dd5ed50793047ff8ca7f044e506b9762022-12-22T02:47:06ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-11-011210.3389/fonc.2022.932212932212Real-world assessment of attenuated dosing anti-PD1 therapy as an alternative dosing strategy in a high-income country (as defined by World Bank)Jia Li Low0Yiqing Huang1Kenneth Sooi2Zhi Yao Chan3Wei Peng Yong4Wei Peng Yong5Soo Chin Lee6Soo Chin Lee7Soo Chin Lee8Boon Cher Goh9Boon Cher Goh10Boon Cher Goh11Department of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore, SingaporeDepartment of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore, SingaporeDepartment of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore, SingaporeDepartment of Pharmacy, National University Hospital, National University Health System, Singapore, SingaporeDepartment of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore, SingaporeCancer Science Institute (CSI), National University Singapore, Singapore, SingaporeDepartment of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore, SingaporeCancer Science Institute (CSI), National University Singapore, Singapore, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeDepartment of Hematology-Oncology, National University Cancer Institute (NCIS), Singapore, SingaporeCancer Science Institute (CSI), National University Singapore, Singapore, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeThe 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.https://www.frontiersin.org/articles/10.3389/fonc.2022.932212/fullPDL1attenuatedlung cancerimmunotherapyimmune check inhibitor (ICI)dose |
| spellingShingle | Jia Li Low Yiqing Huang Kenneth Sooi Zhi Yao Chan Wei Peng Yong Wei Peng Yong Soo Chin Lee Soo Chin Lee Soo Chin Lee Boon Cher Goh Boon Cher Goh Boon Cher Goh Real-world assessment of attenuated dosing anti-PD1 therapy as an alternative dosing strategy in a high-income country (as defined by World Bank) Frontiers in Oncology PDL1 attenuated lung cancer immunotherapy immune check inhibitor (ICI) dose |
| title | Real-world assessment of attenuated dosing anti-PD1 therapy as an alternative dosing strategy in a high-income country (as defined by World Bank) |
| title_full | Real-world assessment of attenuated dosing anti-PD1 therapy as an alternative dosing strategy in a high-income country (as defined by World Bank) |
| title_fullStr | Real-world assessment of attenuated dosing anti-PD1 therapy as an alternative dosing strategy in a high-income country (as defined by World Bank) |
| title_full_unstemmed | Real-world assessment of attenuated dosing anti-PD1 therapy as an alternative dosing strategy in a high-income country (as defined by World Bank) |
| title_short | Real-world assessment of attenuated dosing anti-PD1 therapy as an alternative dosing strategy in a high-income country (as defined by World Bank) |
| title_sort | real world assessment of attenuated dosing anti pd1 therapy as an alternative dosing strategy in a high income country as defined by world bank |
| topic | PDL1 attenuated lung cancer immunotherapy immune check inhibitor (ICI) dose |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.932212/full |
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