Eco Friendly and Budget Smart: An Economic and Environmental Evaluation of Alternative PD-1 and PD-L1 Inhibitor Dosing Regimens.

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.