The Unsustainable Costs of Prolonged Targeted Therapy in Lung Cancer, Saving Methodology
Helmy M Guirgis.
Background: Anticancer drug costs were reported proportional to number of purchases and/or duration of use. The monoclonal antibodies (MABs) were approved at 2-years and targeted therapy (TT) at 3. The value of MABs and TT have been extensively addressed and confirmed, but costs have rarely been dissected. After careful accounting of prolonged TT high costs, saving methodology is being presented in advanced/metastatic non- squamous cell lung carcinoma (a/d-NSCLC).
Methods: MABs costs were calculated as dose in mg x price x number of cycles or years and TT as the monthly optimal dose x 12 x duration of use. Results: The median yearly cost of MABs, approved at 2-year overall survival, was $163,640 with an optional 3rd year totaling $490,920. The annual TT median cost was $229,600, 4- years $918,400 and10-years $2,296,000. Costs counting starts the 1st- year and saving on 4. We reasoned that if 1,000-2000 American patients were treated by all TT for 4-years, cost would mount to $918,400,000 - $1,836,800,000. In Europe with a larger population number, the cost would be higher. TT is essentially unaffordable for patients and counties with limited resources.
Conclusion: In a/d-NSCLC, the use of a 3rd year-MABs is questionable due to lack of extended survival. A 50% reduction of TT annual costs beginning the 4th-year, would circumvent and attenuate the unsustainable economic burden of prolonged use.
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