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

## TL;DR

This study explores the financial impact of using nivolumab with chemotherapy for early-stage lung cancer in Chile, showing potential cost savings and better patient outcomes.

## Contribution

The study provides the first exploratory budget impact analysis of neoadjuvant nivolumab for NSCLC in Chile's public healthcare system.

## Key findings

- The alternative scenario (N + CT) reduces total treatment costs by 6.3% compared to the baseline chemotherapy scenario.
- Early use of nivolumab decreases the need for expensive later-stage treatments like 1L and 2L therapies.
- The highest cost drivers in the alternative scenario are the N + CT treatment and resection.

## Abstract

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.

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)].

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).

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.