Bhuvana Sagar, MD: In lung cancer, we have immunotherapies that have been approved, and they’ve added, significantly, to the total cost of care. Chemotherapy, by itself, was running in the thousands of dollars. When you added supportive care, it added, significantly, to the cost. Targeted therapy added another layer of complexity, and so did VEGF (vascular endothelial growth factor) inhibitors.

Now, we’re in the era of immunotherapy drugs. Immunotherapy drugs have added significantly to the cost pressure, overall. And while they improve survival in a small subset of patients (maybe 20% or 25% of patients have long-term survival benefit) it would be ideal if we can identify those patients who benefit from the drug and not have to treat everybody. That would be the ideal situation (like with Herceptin [trastuzumab]). If you’re able to target patients who have HER2-positive cancers, and you benefit them, that’s great. But at this point, I don’t think we have been able to identify who clearly benefits. We know that patients who have greater than 50% PD-L1 (programmed death-ligand 1)–positive tumors benefit more than the patients who have less positive tumors. Beyond that, it has not been a clear influence on treatment decisions.

At this time, we are not making coverage determinations based on cost only. We are making coverage decisions based on clinical trial evidence and if there is benefit to doing the therapy. So, we don’t deny a drug just because it is expensive or cover a drug just because it is cheap (at this point). We would like to drive affordability, if there are 2 different drug regimens and they both offer similar survival benefit, ideally. There should be a reason as to why we are not choosing the more affordable regimen. But at this time, we do not make coverage decisions based on only cost.

Considering Real-World Outcomes in NSCLC

Bhuvana Sagar, MD, reviews second-line treatment options in non–small cell lung cancer and treatment cost versus value.
Published Online: August 02, 2017


Bhuvana Sagar, MD: In lung cancer, we have immunotherapies that have been approved, and they’ve added, significantly, to the total cost of care. Chemotherapy, by itself, was running in the thousands of dollars. When you added supportive care, it added, significantly, to the cost. Targeted therapy added another layer of complexity, and so did VEGF (vascular endothelial growth factor) inhibitors.

Now, we’re in the era of immunotherapy drugs. Immunotherapy drugs have added significantly to the cost pressure, overall. And while they improve survival in a small subset of patients (maybe 20% or 25% of patients have long-term survival benefit) it would be ideal if we can identify those patients who benefit from the drug and not have to treat everybody. That would be the ideal situation (like with Herceptin [trastuzumab]). If you’re able to target patients who have HER2-positive cancers, and you benefit them, that’s great. But at this point, I don’t think we have been able to identify who clearly benefits. We know that patients who have greater than 50% PD-L1 (programmed death-ligand 1)–positive tumors benefit more than the patients who have less positive tumors. Beyond that, it has not been a clear influence on treatment decisions.

At this time, we are not making coverage determinations based on cost only. We are making coverage decisions based on clinical trial evidence and if there is benefit to doing the therapy. So, we don’t deny a drug just because it is expensive or cover a drug just because it is cheap (at this point). We would like to drive affordability, if there are 2 different drug regimens and they both offer similar survival benefit, ideally. There should be a reason as to why we are not choosing the more affordable regimen. But at this time, we do not make coverage decisions based on only cost.
View More From This Discussion
Episode 1 Clinical Pathways in Lung Cancer
Episode 2 Integrating New Lung Cancer Drugs Into a Formulary
Episode 3 Molecular Testing in NSCLC and Cost
Episode 4 Assessing Options in Second-Line NSCLC
Episode 5 Current Biomarkers in Lung Cancer
Episode 6 Cost-Benefit Analysis in Lung Cancer
Episode 7 Outcomes-Based Contracting in Lung Cancer
Episode 8 Frontline Decision Making in Nondriver Lung Cancer
Episode 9 Deciding on Second-Line Lung Cancer Therapy
Episode 10 Role of Immunotherapy in Lung Cancer
Episode 11 Rationale for Anti-Angiogenesis in Lung Cancer
Episode 12 Alternative Payment Models and Quality in Lung Cancer
Episode 13 The REVEL Study in Lung Cancer
Episode 14 Lung Cancer: Novel Combinations
Episode 15 Clinical Pathways in NSCLC
Episode 16 Communicating Policy Changes in Lung Cancer
Episode 17 Molecular Testing Coverage Decisions in Lung Cancer
Episode 18 Second-Line NSCLC Coverage Decisions
Episode 19 Considering Real-World Outcomes in NSCLC
Episode 20 Incentivizing Quality Care in NSCLC
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