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Aims: Present cost-effectiveness analysis of nivolumab monotherapy vs commonly prescribed third-line (3L+) treatment in small cell lung cancer (SCLC). Materials and methods:A three health states partitioned survival model (progression-free, progressed disease, and death; US payer perspective) was developed. Systematic literature review identified no randomized controlled or single-arm trials with separate outcomes for 3L+ SCLC patients. Topotecan was chosen as comparator because it is frequently prescribed in realworld practice for 3L SCLC. Clinical inputs for topotecan were derived from the Flatiron database with inclusion/exclusion criteria matched to patients treated with 3L+ nivolumab in CheckMate 032. Intravenous (IV) and oral topotecan clinical efficacy were assumed equivalent.Base-case analysis used a 20-year lifetime horizon. An annual discount rate of 3.0% for costs and outcomes was applied. Uncertainty was assessed using sensitivity analyses adjusted for key parameters.Results: Incremental cost per quality-adjusted life-year (QALY) gained with nivolumab was US$153,312 vs IV topotecan and US$123,003 vs oral topotecan, respectively. When results were disaggregated, nivolumab-related costs were mainly driven by drug acquisition costs, and topotecan-related costs were primarily due to adverse event treatment. Mean overall survival (OS) was 21.69 months with nivolumab and 5.80 months with IV or oral topotecan. More favorable outcomes were found by the landmark response analyses. Deterministic sensitivity analyses showed that changes to the discount rate for costs and outcomes and body weight had the greatest impacts on results. A c c e p t e d M a n u s c r i p t Limitations: Included use of real-world data for OS outcomes associated with 3L topotecan, use of second-line topotecan data for progression-free survival, and no indirect costs. Conclusions:Based on the literature on willingness-to-pay for a QALY in metastatic cancer, nivolumab monotherapy might represent a cost-effective option for 3L+ treatment of SCLC compared with IV and oral topotecan. Sensitivity analysis using response-based methods yielded further favorable cost-effectiveness estimates.

Objectives: To evaluate the cost-effectiveness of treating relapsed/refractory multiple myeloma (RRMM) with carfilzomib, lenalidomide plus dexamethasone (KRd) compared to lenalidomide plus dexamethasone (Rd) and with carfilzomib plus dexamethasone (Kd) versus bortezomib plus dexamethasone (Vd) from a Colombian third-party payer perspective. Methods: An economic model was developed to estimate the treatment acquisition costs relative to treatment outcomes for KRd versus Rd and Kd versus Vd in the treatment of RRMM. Efficacy data were based on the ASPIRE and ENDEAVOR head-to-head pivotal trials comparing the therapies of interest. Only treatment acquisition costs were considered and were obtained from local price databases and expressed in local currency. Results were expressed as incremental cost per incremental month of duration of response (DOR), progression free survival (PFS) and overall survival respectively. A threshold of 3 times GDP per capita (63M COP) was considered to assess the comparative cost-effectiveness of each intervention. A scenario considering no drug wastage was also explored. Results: Both combinations with carfilzomib (KRd and Kd) were cost-effective (,3 times GDP per capita) compared to Rd and Vd respectively. For Kd versus Vd, ICERs ranged between 37.19M COP and 53.33M COP, with median DOR being the scenario with the lowest ICER, followed by median PFS. For KRd versus Rd, median PFS provided the most cost-effective scenario followed by median OS, within a 52.95M to 62.26M COP ICER range. When no drug wastage was considered, ICERs were lower by 19% across all outcomes compared to the base case analysis. Conclusions: Carfilzomib is likely to be a cost-effective treatment option for RRMM patients from a third-party payer perspective in Colombia, attributable to its demonstrated superior clinical profile. Further analysis including other direct medical costs, discounts and survival estimate variations is warranted to assess additional foreseeable gains/savings.

As the average life expectancy of Koreans increases, the prevalence of prostate cancer (Pca) is increasing in men aged 70 years or older. But, in the absence of pattern data of primary treatment for elder patients was unable to health care policy for prostate cancer. This study aims to examine the medical patterns of major for prostate cancer. MethOds: The treatment patterns of Pca were analyzed by using the linked data of the Korea Central Cancer Registry and National Health Insurance Service (NHIS), using International Classification of Diseases, 10th diagnosis codes. To analyze the status of medical use of Pca, the database of NHIS claims in 2002-2014 was used. The treatment pattern due to Pca were investigated according to year based on the details of age, insurance type, primary treatment type, hospital type, comorbidity and cancer stage. Results: Overall 71,223 patients were identified and 45,197 new medical users were selected. In terms of the stage of cancer, the proportion of 'Localized' group increased from 46% in 2005 to 58% in 2013. Patients that the Charlson's Comorbidity Index is 1 point at the time of the first diagnosis had the most proportion at 26.78%, and the proportion of 4 points or more tended to increase annually for 11 years from 2003 to 2013. However, there was a continuous increasing trend in surgery (including robot surgery) from 23.7% in 2003 to 48.5% in 2013. Among those who received hormone therapy as a first treatment in patients aged 75-79 increased annually from 20.8% in 2003 to 27.3% in 2013, and patients aged 80 or more tended to increase. cOnclusiOns: Considering the increased prevalence of elder patients with Pca, it is important to understand the real-world status of medical treatment and to generate evidence for support decision-making of national health policy in Korea.

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