The economic and clinical impact of lung cancer patient support programs (LC-PSP) using real-world (RW) clinical outcomes.

Abstract

e23026 Background: Timely access to precision therapies is critical to improving lung cancer outcomes. Canada’s universal healthcare system supports access to essential oncology drugs, but complex and lengthy approval and funding processes often delay access to novel therapies. PSPs provide access to novel therapies in the pre-funding period. This study assesses the clinical and economic impact of LC-PSPs over the past decade. Methods: Clinical outcomes (PFS, OS, and treatment duration) for individuals receiving drugs via an LC-PSP were obtained from a provincial lung cancer database in Alberta, Canada. Clinical trial data, health-utility indices (HUI), cost-effectiveness data (ICER), unsubsidized drug costs from Canada’s Drug Agency (CDA), and approval and funding dates from Health Canada & Alberta Health Services informed estimates of person life years gained (PLYG) on LC-PSP drugs, the economic value of quality-adjusted life years (QALY) gained, total value of drugs provided, and the median interval between drug approval and funding in Alberta, respectively. PLGY and QALY were calculated as: 1) PLYG: The difference between observed and estimated PFS or OS. Estimates were calculated by multiplying the pivotal clinical trial hazard ratio by observed PFS or OS. 2)cQALY: PLGY multiplied by the drug-specific HUI to adjust for quality of life. 3) Economic value of QALY (in Canadian dollars): QALY multiplied by drug-specific ICER. Results: 146 patients received novel therapies via 14 different LC-PSPs between 2015 and 2025. 66% were female and median at age diagnosis was 60 years. 67% of LC-PSP drugs provided were targeted oral inhibitors for actionable alterations [ ALK (crizotinib, alectinib, lorlatinib) , EGFR (afatinib, dacomitinib, osimertinib) , RET (selpercatinib) , and ROS1 (crizotinib)], 17% immune checkpoint inhibitors (neoadjuvant nivolumab), 12% other monoclonal antibody (amivantamab), and 3% T-cell engagers (tarlatamab). Median delay between HC approval and funding was 843 days (range: 260 – 1338). Median PLYG (months) for PFS and OS were 9.1 (QALY value: $119,730.60 CAD) and 14.5 (QALY value: $185,917.87 CAD), respectively. Total value of drugs provided through these 14 LC-PSP was $2.4 million CAD. Conclusions: This RW study shows that LC-PSPs provide substantial financial value and critically bridge the > 2-yr gap between HC approval and provincial funding for novel lung cancer therapies. Our findings reflect meaningful patient benefit through inferred survival gains and improved quality of life from extended disease control and underscore the need to reform regulatory processes to ensure equitable access to effective new therapies. Opportunities, including navigation support, to strengthen interim access through efficient identification of eligible patients and streamlining PSP applications will further enhance access to unfunded yet clinically meaningful therapies.