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Purpose <p>Effective and sustainable treatments to improve patient outcomes are urgently needed for non-small cell lung carcinoma (NSCLC). Neoadjuvant therapies, particularly nivolumab, have shown superior outcomes in event-free survival and pathological response, yet financial coverage is scarce. We aim to provide an exploratory economic analysis to assess the implications of its incorporation into routine clinical practice.</p> Methods <p>We conducted a six-step BIA (budget impact analysis) based on a decision tree model for pathways, probabilities, and resource utilization from the national payer perspective at an event-free survival (EFS) horizon. We estimated the direct cost of drugs and all healthcare-related services for two scenarios: a baseline scenario [neoadjuvant chemotherapy (CT)] and an alternative scenario [neoadjuvant nivolumab combined with chemotherapy (N + CT)].</p> Results <p>The funnel-down technique determined 359 eligible patients nationwide per year. The total cost of treatment in the baseline scenario amounts to CLP $ 7315 million Chilean pesos (€ 8,063,219) per cohort, with three top cost drivers: 1L drugs after recurrence (51.98%), resection (29.33%) and 2L nivolumab (5.85%). The alternative scenario amounted to CLP $ 6853 million (€ 7,553,572), with the highest relative expenditure attributed to the N + CT scheme (61.76%), resection (31.31%), and follow-up (2.73%). Adjuvant costs decrease to 1.03%, as does the expenditure on 1L (51.98% versus 0.34%) and 2L treatments (5.85% versus 0.18%). Early intervention in NSCLC reduces the budgetary impact by 6.3% (savings of −&#xa0;$ 462 million (€ 509,647) per treated cohort).</p> Conclusions <p>Early incorporation of N + CT optimizes healthcare expenditure by providing access to therapies that improve survival rates while reducing the need for costly treatments in advanced stages. This approach represents a dominant strategy.</p>

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Budget impact analysis of neoadjuvant nivolumab for non-small cell lung cancer in the Chilean public healthcare system: An exploratory economic assessment

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月2日

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  • Daniela Paredes-Fernández,
  • Rony Lenz-Alcayaga,
  • Francisco Orlandi-Jorquera

摘要

Purpose

Effective and sustainable treatments to improve patient outcomes are urgently needed for non-small cell lung carcinoma (NSCLC). Neoadjuvant therapies, particularly nivolumab, have shown superior outcomes in event-free survival and pathological response, yet financial coverage is scarce. We aim to provide an exploratory economic analysis to assess the implications of its incorporation into routine clinical practice.

Methods

We conducted a six-step BIA (budget impact analysis) based on a decision tree model for pathways, probabilities, and resource utilization from the national payer perspective at an event-free survival (EFS) horizon. We estimated the direct cost of drugs and all healthcare-related services for two scenarios: a baseline scenario [neoadjuvant chemotherapy (CT)] and an alternative scenario [neoadjuvant nivolumab combined with chemotherapy (N + CT)].

Results

The funnel-down technique determined 359 eligible patients nationwide per year. The total cost of treatment in the baseline scenario amounts to CLP $ 7315 million Chilean pesos (€ 8,063,219) per cohort, with three top cost drivers: 1L drugs after recurrence (51.98%), resection (29.33%) and 2L nivolumab (5.85%). The alternative scenario amounted to CLP $ 6853 million (€ 7,553,572), with the highest relative expenditure attributed to the N + CT scheme (61.76%), resection (31.31%), and follow-up (2.73%). Adjuvant costs decrease to 1.03%, as does the expenditure on 1L (51.98% versus 0.34%) and 2L treatments (5.85% versus 0.18%). Early intervention in NSCLC reduces the budgetary impact by 6.3% (savings of − $ 462 million (€ 509,647) per treated cohort).

Conclusions

Early incorporation of N + CT optimizes healthcare expenditure by providing access to therapies that improve survival rates while reducing the need for costly treatments in advanced stages. This approach represents a dominant strategy.