Karlsson Leo, Ciccolini Joseph, Ter Heine Rob, Centanni Maddalena
Department of Pharmacy, Uppsala University, Box 580, 751 23, Uppsala, Sweden.
COMPO, Inserm U1068 Centre de Recherche en Cancérologie de Marseille & Inria Sophia Antipolis, Marseille, France.
Pharmacoeconomics. 2025 Sep 10. doi: 10.1007/s40273-025-01535-7.
Immune checkpoint inhibitors (ICIs) are clinically beneficial but associated with high costs that represent a growing challenge for healthcare budgets and may affect affordability, especially in resource-limited settings. Moreover, the healthcare sector is a significant source of greenhouse gas emissions, and medication-related waste-such as that from vial-based therapies-has been identified as a contributing factor. Alternative dosing strategies could reduce the environmental and financial impact of ICI therapy while maintaining clinical safety and efficacy.
Population pharmacokinetic simulations were performed using virtual cohorts representative of the original cancer populations treated with ICIs. The analysis was conducted from a Western European hospital perspective, using Dutch public data to estimate costs (based on volume-dependent pricing) and carbon emissions from drug production, travel, and medical waste.
Under the US Food and Drug Administration exposure-matching criteria, optimized dosing regimens reduced drug costs by up to €23,311 (- 28%) and carbon emissions by up to 255 kgCO₂e (- 30%) per patient, depending on the drug and dosing strategy. Using a broader therapeutic window approach, cost savings reached up to €40,135 (- 69%) and carbon reductions up to 501 kgCO₂e (- 63%) per patient. Incorporating vial sharing further increased potential cost savings to €5,721 per patient (- 31%). All estimates reflect European pricing and emissions factors, modeled over an 8-month treatment period.
These findings suggest that optimizing dosing strategies can yield meaningful economic and environmental benefits in ICI therapy while maintaining drug exposure within levels defined by US Food and Drug Administration criteria or broader therapeutic windows. A user-friendly application developed in this study allows users to generate virtual populations and evaluate tailored dosing strategies, facilitating practical implementation in diverse healthcare settings.
免疫检查点抑制剂（ICI）在临床上具有益处，但成本高昂，这对医疗保健预算构成了日益严峻的挑战，可能影响其可及性，尤其是在资源有限的环境中。此外，医疗保健部门是温室气体排放的重要来源，与药物相关的废物（如基于小瓶疗法产生的废物）已被确定为一个促成因素。替代给药策略可以在维持临床安全性和有效性的同时，减少ICI治疗对环境和财务的影响。
使用代表接受ICI治疗的原始癌症人群的虚拟队列进行群体药代动力学模拟。从西欧一家医院的角度进行分析，使用荷兰公共数据来估算成本（基于与体积相关的定价）以及药物生产、运输和医疗废物产生的碳排放。
根据美国食品药品监督管理局（FDA）的暴露匹配标准，优化给药方案可使每位患者的药物成本降低多达23,311欧元（-28%），碳排放减少多达255千克二氧化碳当量（-30%），具体取决于药物和给药策略。采用更宽治疗窗方法，每位患者的成本节约可达40,135欧元（-69%），碳减排可达501千克二氧化碳当量（-63%）。纳入小瓶共享进一步将每位患者的潜在成本节约提高到5,7
