Patient access to precision medicine: Correlation of immune checkpoint inhibitor (ICI) usage in non-small cell lung cancer (NSCLC) with patient household income levels across multiple Asian markets.

person Pieter De Richter Ipsos, Kuala Lumpur, Malaysia info_outline Pieter De Richter, Mei Yee Koo

Authors person Pieter De Richter Ipsos, Kuala Lumpur, Malaysia info_outline Pieter De Richter, Mei Yee Koo Organizations Ipsos, Kuala Lumpur, Malaysia Abstract Disclosures Research Funding No funding received None. Background: 1 st line (1L) advanced/metastatic NSCLC patients wild-type (WT) for EGFR, ALK and ROS1 have been shown to benefit from treatment with ICIs, and these drugs have been incorporated into most treatment guidelines for this cancer. However, some patients cannot afford these costly treatment options, especially in countries where reimbursement coverage is partial/absent. This study uses real-world data to explore the correlation between monthly household income levels (MHHI) and ICI shares in Thailand, Indonesia, Vietnam, Taiwan and mainland China. Methods: Ipsos’ Oncology Monitor is a physician-reported syndicated patient record database. 532 cancer-treating physicians (Thailand = 37, Indonesia = 30, Vietnam = 80, Taiwan = 40, China = 345) were screened for specialty, role and caseload and submitted data on 1,134 1L WT stage IIIB/IV NSCLC patients (aggregate) with known MHHI. Data were collected (online + pen & paper) from July ’21 – June ’22. Results: In all 5 countries, a correlation was observed between MHHI and the percentage of WT patients in each cohort receiving an ICI as part of their current 1L therapy. In Thailand and Vietnam, share of ICIs was ≤10% for patients in the study earning < 39,999 THB and < 12,000,001 VND, respectively. This compared to an ICI share of 79% among the most affluent Thai patients ( > 1,000,000 THB) and 35% among the highest-income Vietnamese patients ( > 12,000,000 VND). In Indonesia, all 8 patients prescribed an ICI were in the highest income bracket ( > 10,000,000 IDR). In Taiwan, the correlation was less pronounced, but those earning < 40,000 NTD per household were still least likely to receive an ICI. In China, patients with a MHHI above 10,000 CNY were most likely to be given an ICI. Conclusions: Results from this study suggest that, among this cohort, there is a clear link between patient household income and likelihood to be prescribed an ICI across 5 different Asian markets. While all patients should have access to the most optimal treatment based on their diagnosis and molecular profile, this does not appear to be a reality in the clinical setting, based on data from this real-world evidence study in Asia. More must be done to ensure equal access to all, regardless of country of residence or income. Thailand Indonesia Vietnam Taiwan China Patient monthly household income level MHHI < 39,999 THB MHHI 40,000 - 100,000 THB MHHI > 100,000 THB MHHI < 5,000,000 IDR MHHI 5,000,000-10,000,000 IDR MHHI > 10,000,000 IDR MHHI < 7,500,000 VND MHHI 7,500,000 - 12,000,000 VND MHHI > 12,000,000 VND MHHI < 40,000 NTD MHHI 40,000-100,000 NTD MHHI > 100,000 NTD MHHI < 7,000 CNY MHHI 7,000-9,999 CNY MHHI > 10,000 CNY n = 20 17 24 32 25 8 42 109 135 24 66 20 141 173 298 % of reported patients in each cohort receiving an ICI as part of their current 1L therapy for WT stage IIIB/IV NSCLC 10% 53% 79% - - 12% 7% 5% 39% 21% 36% 35% 32% 36% 51%