Sustainability of checkpoint inhibitors for the health system

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Sustainability of checkpoint inhibitors for the health system

Lorenzo G Mantovani

Università di Milano -Bicocca

[email protected] ₁

mercoledì 14 giugno 17

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Presentation

• Sustainability of the Healthcare System

• Sustainability of Checkpoint Inhibitors

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Presentation

• Sustainability of the Healthcare System

• Sustainability of Checkpoint Inhibitors

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Death in old age is i n e v i t a b l e , b u t death before old age is not

Richard Doll

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Question

• If a group of individuals representing

20% of a population are generating 65%

of expenditure, what will happen when that group will represent the 30+%?

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Any given morning

• RA 12.000 Euro

• mCRC WT LLD 12.000 Euro

• CLL 12.000 Euro

• Prohpy 12.000 Euro

• Diabetes 12.000 Euro

• HCV 12.000 Euro

• NSCLC IIIb-IV 12.000 Euro

• SO?

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What do we do?

Go to the principles!

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Principle

“All effective treatments should be given free”

Archie Cochrane 1971

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monday morning

• RA 0.8 HAQ

• mCRC WT LLD OS 4.2 m

• CLL PFS 1.1 a

• Prohpy 0.7 bleedings

• Diabetes 1.3 DVQ

• HCC 0.88 SVR

• NSCLC IIIb-IV OS 9 m

• SO?

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What do we do?

Again! Principles!

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Principles

“All cost effective treatments should be given free”

Alan Williams, 1997

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Economics is...

“...

study of how societies use scarce resources to produce valuable

commodities and distribute them among different people”

Paul A Samuelson, Nobel Laureate 1970

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Quality adjusted life years

QALY’s

Cost utility analysis (CUA)

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Cost utility benchmark

• Dialysis

– No dialysis = no life

– 1 year of dialysis = 1 year of life

– 1 year of dialysis = 20-30.000 Euro – 1 year of dialysis = 0.60 QALY gained – 35-50.000 Euro = 1 QALY

• IF

– a QALY is a QALY is a QALY, no matter who gains it – a Euro is a Euro is a Euro, no matter who pays it

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Opportunity cost

• Economists define costs in terms of benefit forgone

• The cost of a healthcare intervention is the benefit forgone from other

interventions that could have been

implemented with the same resources

• The cost of treating mr Green, is the benefit forgone for not being able to treat Mr Brown

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CEA of Checkpoint inhibitors

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Presentation

• Sustainability of the Healthcare System

• Sustainability of Checkpoint Inhibitors

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Cost effective?

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Identification of patients

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Selection of treatment

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Diagnosis-treatment-follow-up

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^PAS

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Appropriateness?

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the right patient

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the right drug

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the right team

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the right cost

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Sustainability?

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Principles

“All cost effective treatments should be given free”

Alan Williams, 1997

“All sustainable treatments will be given free”

Mantovani, Strazzabosco e Cortesi, 2016

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Economics is...

“ The decision maker has a choice between optimal decisions for an imaginary simplified world or

decisions that are "good enough, that satisfice”, for a world approximating the complex real one more closely.”

Herbert A Simon, Nobel Laureate 1978