Cost-efficiency and budget-neutral expanded access modeling of the novel PD-1 inhibitor toripalimab versus pembrolizumab in recurrent or metastatic nasopharyngeal carcinoma

Abstract

Aims

To estimate, in the setting of recurrent or metastatic nasopharyngeal carcinoma (R/M NPC) for an assumed 1,207 incident US cases in 2024, (1) the cost-efficiency of a toripalimab-gemcitabine-cisplatin regimen compared to a similar pembrolizumab regimen; and (2) the budget-neutral expanded access to additional toripalimab cycles and regimens afforded by the accrued savings.

Methods

Simulation modeling utilized two cost inputs (wholesale acquisition cost (WAC) at market entry and an ex ante toripalimab price point of 80% of pembrolizumab average sales price (ASP)) and drug administration costs over 1 and 2 years of treatment with treatment rates ranging from 45% to 90%. In the absence of trial data for pembrolizumab-gemcitabine-cisplatin in R/M NPC, it is assumed that such a regimen would be comparable to toripalimab-gemcitabine-cisplatin in efficacy and safety.

Results

In the models utilizing the WAC, toripalimab saves $2,223 per patient per cycle and $40,014 over 1 year of treatment ($77,805 over 2 years). Extrapolated to the 1,207-patient panel, estimated 1-year savings range from $21,733,702 (45% treatment rate) to $43,467,404 (90% rate). Reallocating these savings permits budget-neutral expanded access to an additional 2,359 (45% rate) to 4,717 (90% rate) toripalimab maintenance cycles or to an additional 126 (45% rate) to 252 (90%) full 1-year toripalimab regimens with all agents. Two-year savings range from $42,259,976 (45% rate) to $84,519,952 (90% rate). Reallocating these efficiencies provides expanded access, ranging from an additional 4,586 (45% rate) to 9,172 (90% rate) toripalimab cycles or to an additional 128–257 full 2-year toripalimab regimens. The ex ante ASP model showed similar results.

Conclusion

This simulation demonstrates that treatment with toripalimab generates savings that enable budget-neutral funding for up to an additional 252 regimens with toripalimab-gemcitabine-cisplatin for one full year, the equivalent of approximately 21% of the 2024 incident cases of R/M NPC in the US.

PLAIN LANGUAGE SUMMARY

An estimated 1,207 patients will be diagnosed with late-stage nasopharyngeal cancer in the US in 2024. Toripalimab is a novel PD-1 inhibitor drug approved by the US Food and Drug Administration on October 27, 2023 as first-line treatment for patients with recurrent or metastatic nasopharyngeal cancer when used in combination with gemcitabine and cisplatin. We conducted economic evaluations of the costs of this toripalimab regimen versus the costs of a similar regimen with the PD-1 inhibitor pembrolizumab. Our simulation models used two pricing scenarios: the wholesale acquisition cost (WAC) or “list price” at market entry and, as no average sales price (ASP) will be available for toripalimab for several quarters, an estimated toripalimab price point of 80% of the pembrolizumab ASP. We compared the savings in each scenario when between 45% and 90% of the 1,207 patients are treated with the toripalimab regimen. We then evaluated how these savings could be re-allocated, on a budget-neutral basis and without requiring extra cash outlays, to provide more patients with access to toripalimab treatment; specifically, how many toripalimab doses and how many full toripalimab regimens could be purchased to provide more patients with treatment. We found that, if 90% of new cases of recurrent or metastatic nasopharyngeal cancer were treated with toripalimab over 1 year, these savings are enough to purchase up to 4,717 additional doses on a budget-neutral basis, which could provide up to an additional 252 newly diagnosed patients with 1 year of treatment with toripalimab. In combination with gemcitabine and cisplatin, toripalimab can markedly improve access to care for patients with recurrent or metastatic nasopharyngeal cancer in a cost-responsible way.

Keywords:

• Toripalimab
• PD-1 inhibitor
• nasopharyngeal carcinoma
• cost-efficiency
• expanded access
• metastatic cancer
• pharmacoeconomics

JEL CLASSIFICATION CODES:

• I11
• I13

Transparency

Declaration of funding

This study was sponsored by Coherus BioSciences, Inc., Redwood City, CA, USA.

Declaration of financial/other interests

MP is an employee of Coherus BioSciences, Inc., the study sponsor. KM and IA are owners of Matrix45, which was contracted by Coherus BioSciences, Inc. to conduct this study. By company policy, owners and employees are prohibited from owning equity in sponsor organizations (except through mutual funds or other independently administered collective investment instruments) or contracting independently with client organizations. IA serves on a Speakers Bureau for Coherus BioSciences, Inc., the study sponsor. IA is Editor-in-Chief of the Journal of Medical Economics. He was not involved in any editorial decisions regarding this manuscript.

Author contributions

All authors met ICMJE and COPE criteria and contributed substantively to the study as follows: Study concept: KM, IA; Study design: KM, IA; Model development and simulations: KM, IA; Review and interpretation of results: KM, IA, MP; Development of manuscript: KM, IA, MP; Review of the manuscript for intellectual content: KM, IA, MP.

Reviewer disclosures

Peer reviewers on this manuscript have received an honorarium from JME for their review work but have no other relevant financial relationships to disclose.

Previous presentations

An earlier version of this analysis was presented as a poster at AMCP-Nexus 2022 and published as an abstract (MacDonald K, Walden P, Geller R, Abraham I. Cost-efficiency and budget-neutral expanded access modeling of PD-1 inhibitor toripalimab plus gemcitabine-cisplatin over a simulated parallel pembrolizumab regimen for treatment of recurrent or metastatic naso-pharyngeal cancer. J Manag Care Spec Pharm 2022;28(Suppl 10a):S14.

Notes

i Hereafter referred to as toripalimab.