Economic Impact of Targeted and Immunotherapies in Treating Operable Esophageal and Non-Small Cell Lung Cancers.

Background: As the therapeutic landscape evolves, we aim to evaluate the cost implications of National Comprehensive Cancer Network-recommended perioperative targeted/immunotherapies for non-small cell lung cancers (NSCLCs) and esophageal cancers. Methods: The Medicare Part B payment allowance limits of treatment were ascertained. Using published data, we estimated the annual incidence of eligible patients. We applied the estimated cost of the medication based on treatment dosing and duration. The costs per patient and incident cohort were calculated. Results: We estimated that 8602 patients with newly diagnosed esophageal cancers would be eligible for adjuvant nivolumab. The cost to treat 1 patient was $190,000, and the cost to treat 1 incident cohort was $1.6 billion. We estimated that 50,409 patients with NSCLC will meet the criteria for neoadjuvant nivolumab with a cost of 3 cycles of $32,000 per patient and $1.7 billion per cohort. Among NSCLC patients who may undergo resection and qualify for adjuvant therapy, 70,602 patients are anticipated to be epidermal growth factor receptor-negative and treated with adjuvant atezolizumab or pembrolizumab. Treatment costs range from $178,000 to $197,000 per patient, with up to $13.9 billion cost per cohort. The cost to treat 1 patient with adjuvant osimertinib was $556,000, with an incident cohort cost of $8 billion. The cost to treat an incident cohort of eligible thoracic malignancies is estimated at $25 billion. Conclusions: Immune and targeted therapy in operable thoracic patients is associated with a significant cost burden. Studies are needed to assess cost-effectiveness to ensure optimal resource allocation and improve patient outcomes.