{"entity":{"id":"idea-cost-extended-interval-default","kind":"idea","name":"Make six-weekly immunotherapy the default schedule","aka":[],"tldr":"Pembrolizumab 400 mg every six weeks is approved and works like 200 mg every three weeks, and it halves the number of clinic visits, infusion chairs and travel days without changing the drug bill.","summary":"The FDA approved pembrolizumab 400 mg every six weeks in 2020 on pharmacokinetic modelling and later clinical data; nivolumab 480 mg every four weeks has a similar basis. The drug quantity is the same, so the saving is in administration fees, chair time, staff, and patients' travel and time off work. Many practices still default to three-weekly schedules. A default schedule change in electronic order sets, with the shorter interval reserved for patients who need frequent review, is the cheapest capacity gain available in immunotherapy.","asOf":"2026-09-10","links":[{"label":"FDA: pembrolizumab label (Drugs@FDA)","url":"https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=125514"}],"tags":[],"related":[],"cancers":[],"sections":["immunotherapy"],"technologies":["checkpoint-inhibitor"],"targets":[],"drugs":["pembrolizumab","nivolumab"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-dose-optimisation","b-care-fragmentation","b-workforce"],"keyPapers":["paper-checkmate-017-nejm-2015","paper-keynote-189-nejm-2018","paper-keynote-564-nejm-2021"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Default extended-interval ordering will halve infusion visits for eligible patients within six months, reduce administration and travel cost per patient by at least 40%, and show no difference in survival or immune-related toxicity.","rationale":"The regulator has already accepted equivalence; the barrier is order-set inertia and fee-for-visit payment.","test":"Health-system order-set change with a difference-in-differences comparison against systems that did not switch, on visits, costs, adverse events and survival.","maturity":"being-tested-at-scale","actor":"clinic","cost":"small","horizonYears":1},"route":"/ideas/idea-cost-extended-interval-default/","neighbours":{"section":[{"id":"immunotherapy","kind":"section","name":"Immunotherapy","route":"/fronts/immunotherapy/"}],"technology":[{"id":"checkpoint-inhibitor","kind":"technology","name":"Immune checkpoint inhibitors","route":"/technologies/checkpoint-inhibitor/"}],"drug":[{"id":"nivolumab","kind":"drug","name":"Nivolumab","route":"/drugs/nivolumab/"},{"id":"pembrolizumab","kind":"drug","name":"Pembrolizumab","route":"/drugs/pembrolizumab/"}],"bottleneck":[{"id":"b-care-fragmentation","kind":"bottleneck","name":"Fragmented care and guideline gaps","route":"/bottlenecks/b-care-fragmentation/"},{"id":"b-workforce","kind":"bottleneck","name":"Not enough oncologists, nurses, pathologists, physicists","route":"/bottlenecks/b-workforce/"},{"id":"b-dose-optimisation","kind":"bottleneck","name":"Wrong doses","route":"/bottlenecks/b-dose-optimisation/"}],"paper":[{"id":"paper-checkmate-017-nejm-2015","kind":"paper","name":"CheckMate 017: nivolumab beats docetaxel in squamous lung cancer after chemotherapy","route":"/key-papers/paper-checkmate-017-nejm-2015/"},{"id":"paper-keynote-189-nejm-2018","kind":"paper","name":"KEYNOTE-189: pembrolizumab plus chemotherapy as first treatment for non-squamous lung cancer without a driver mutation","route":"/key-papers/paper-keynote-189-nejm-2018/"},{"id":"paper-keynote-564-nejm-2021","kind":"paper","name":"KEYNOTE-564: a year of pembrolizumab after kidney cancer surgery","route":"/key-papers/paper-keynote-564-nejm-2021/"}]}}