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

Abstract

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.