Health impact of using anti-PD-(L)1 agents to treat early-stage cancers in Switzerland: a modeling study.

Background: Inhibitors of programmed cell death protein 1 (PD-1) and its ligand (PD-L1) (referred to hereafter as anti-PD-(L)1 agents) are approved to treat a variety of advanced-stage cancers. Incorporating these agents into neoadjuvant/adjuvant treatment regimens for early-stage cancers may provide health and economic benefits at the population level. Methods: A health outcomes projection model compared two scenarios in Switzerland: I) anti-PD-(L)1 agents used only for advanced/metastatic disease, and II) anti-PD-(L)1 agents starting in the neoadjuvant/adjuvant setting. The model focused on three cancers for which anti-PD-(L)1 agents are currently approved in Europe in early stages: melanoma, renal cell carcinoma (RCC), and triple-negative breast cancer (TNBC), projecting clinical evolution over 10 years. Estimated outcomes included life-years, quality-adjusted life-years (QALYs), recurrences/events, active treatments for metastatic disease, adverse events, and deaths. Results: Of the estimated 10,659 eligible patients during 2022-2031, 9,050 were predicted to initiate neoadjuvant and/or adjuvant treatment with anti-PD-(L)1 agents for treatment of melanoma, RCC, or TNBC. Compared to anti-PD-(L)1 agents being available only in the metastatic setting, use of anti-PD-(L)1 agents in the neoadjuvant and/or adjuvant setting for these 3 cancers was projected to avoid 1,144 recurrences (a 27% decrease), prevent 1,577 active treatments in the metastatic setting (a 35% decrease), avoid 530 deaths (a 23% decrease), and increase life-years without recurrence by 3,416 (a 10% increase). Conclusion: The use of anti-PD(L)1 agents to treat early-stage cancers in Switzerland is anticipated to result in better outcomes by preventing recurrences/events, active metastatic treatments, and deaths.