Health and productivity benefits of anti-PD-(L)1 agents for early-stage cancer treatment in Hungary

Anti-PD-(L)1 agents, inhibitors of programmed cell death protein 1 (PD-1) or its ligand (PD-L1), are established therapies that improve cancer management as well as the disease and societal burden of specific metastatic and early-stage cancers. The aim of the study was to determine the impact of adopting anti-PD-(L)1 agents for the treatment of all eligible patients with early-stage cancers versus reserving anti-PD-(L)1 agents for patients with metastatic disease alone in Hungary. This study evaluated two scenarios, one where anti-PD-(L)1 agents were used to treat all eligible early-stage disease cases (ESD scenario) of melanoma (stage IIB-C and III), renal cell carcinoma (RCC), and triple-negative breast cancer (TNBC) versus a reference scenario where anti-PD-(L)1 agents were only used to treat metastatic disease cases in Hungary (2024–2033). A Markov-modeling approach estimated the health outcomes and productivity losses from each scenario from a societal perspective. Outcomes included recurrence-/event-/disease-free life-years, total life-years, quality-adjusted life-years (QALYs), productive years (patients and caregivers), recurrences/events, active treatments for metastatic disease, and deaths. The cumulative health and productivity impact of ESD treatment with anti-PD-(L)1 agents in Hungary was the difference in health and productivity outcomes between the ESD and reference scenarios for the time horizon of the model. ESD treatment with anti-PD-(L)1 agents was estimated to increase recurrence-/event-/disease-free life-years (+13.8%), total life-years (+3.7%), and QALYs (+4.7%), as well as productive work years for patients (+39.6%) and caregivers (+27.6%). Concurrently, there would be fewer recurrences/events (−31.0%), active treatments for metastatic disease (−34.0%), post-recurrence deaths (−30.3%), and total deaths (−23.1%). Investing in anti-PD-(L)1 agents for early-stage disease may not only increase the life expectancy and QALYs for patients in Hungary but also increase productive work years for both patients and caregivers in Hungary. In addition, it may also help to reduce metastatic disease treatments and cancer-related deaths. Immunotherapies such as anti-PD-(L)1 therapies help the immune system destroy harmful cancer cells. They are standard treatments for advanced (metastatic) cancers, but their use is expanding to patients with early-stage cancers such as early-stage melanoma (stage IIB-C and III), renal cell carcinoma (RCC), and triple-negative breast cancer (TNBC). Although the number of cancer cases in Hungary has declined in recent years, cancer-related deaths remain high, indicating a need for better healthcare access with effective treatment options. This study uses a previously established model to evaluate the impact of anti-PD-(L)1 therapies for early-stage cancer treatment versus only using them for advanced disease in Hungary (status quo) from 2024 to 2033. Cumulatively, it was found that early disease treatment with anti-PD-(L)1 therapies compared to the status quo would result in a 13.8% increase in the number of years patients live cancer-free (recurrence-/event-/disease-free life-years), and a 4.7% increase in quality-adjusted life-years (QALYs; the number of years patients live longer and feel better). Additionally, the better health and well-being would extend productive work years for patients and their caregivers by 39.6% and 27.6%, respectively. Lastly, early-stage cancer treatment with anti-PD-(L)1 agents would reduce cancer recurrences by 31.0%, metastatic disease treatments by 34.0%, and total deaths by 23.1%. Overall, the use of anti-PD-(L)1 therapies for early-stage melanoma, RCC, and TNBC may significantly improve the burden of cancer in Hungary by improving overall survival, quality of life, and productivity, ultimately reducing the public health burden.