Modeling Cancer Outcomes and Economic Impact of the Anti-PD-1/PD-L1 Immunotherapy in the Gulf: United Arab Emirates, Oman, and Kuwait.

BACKGROUND AND OBJECTIVES: Cancer has a substantial health and economic impact on the populations of the Gulf countries-the United Arab Emirates (UAE), Kuwait, and Oman; however, uncertainty remains among decision-makers, payers, and stakeholders regarding their clinical and economic advantages. Hence, this study aims to evaluate the potential health and economic impact of programmed cell death protein 1 (PD-1) and programmed cell death-ligand 1 (PD-L1) inhibitor immunotherapies to reduce uncertainty and inform coverage, reimbursement, and treatment decisions across the Gulf region. METHODS: The Health Impact Projection (HIP) model, a partitioned survival model, was adapted from a payer perspective for the UAE, Oman, and Kuwait to explore the health and economic impact of the anti-PD-1/PD-L1 class over 2022-2026 among key indications, including: first line non-squamous non-small cell lung cancer (1LNSCLC), neo-adjuvant triple-negative breast cancer (TNBC), metastatic TNBC, head and neck cancer, 1L metastatic urothelial carcinoma, metastatic renal cell carcinoma (RCC), second line endometrial cancer, 1L cervical cancer, and colorectal cancer. The model adopted a 1-to-5-year time horizon, structured in weekly cycles, with a new cohort joining yearly. Model inputs were based on publicly available data, literature, and expert advice. RESULTS: The model estimated that, over 5 years, 3763 patients across the UAE, Kuwait, and Oman would receive anti-PD-1/PD-L1s treatments, resulting in total gains of 1745 life years, 2791 progression-free survival (PFS) years, and 1625 quality adjusted life-years (QALYs). The introduction of anti-PD-1/PD-L1s would have an average annual impact of $149 million and a 0.17% share of healthcare expenditure in 2022. While disease management and drug acquisition costs are significant, they are partly offset by reductions in end-of-life costs ($1,011,773/year) and cancer-related productivity losses ($3,111,454/year). CONCLUSIONS: The HIP model aids horizon scanning by providing a framework for stakeholder discussions on equitable access to anti-PD-1/PD-L1 treatments. It highlights the notable survival and QoL benefits of this novel class in Gulf countries, achievable with a modest 0.17% increase in healthcare expenditure.