Pembrolizumab as second-line therapy in non-small cell lung cancer in northern Norway: budget impact and expected gain—a model-based analysis

Abstract

BackgroundPembrolizumab is a new drug approved in several countries for second-line therapy in non-small cell lung cancer (NSCLC) being programmed cell death ligand (PD-L1) positive. This drug has a high cost, and the cost-effectiveness ratio has been debated.Patients and methodsThe budget impact to the Northern Norwegian Regional Health Authority trust of implementing pembrolizumab in second-line therapy in patients with PD-L1-positive NSCLC was calculated. A model was developed employing data from the Cancer Registry of Norway, the KEYNOTE-010 study, the price list from The Hospital Pharmacy of North Norway, the cost of analysing PD-L1 expression and the cost of travelling. Today’s cost of second-line therapy was compared with the new standard employing pembrolizumab. The sale price of pembrolizumab in Norway was not published due to price confidentiality. Norwegian krone (NKr) was converted into Euros (€) at a rate of 1€=Nkr 8.8138. (Bank of Norway, 21 February 2017).Results105 new patients were identified available for pembrolizumab per year. The annual cost of pembrolizumab was €5.2 million, hospital pharmacy administration costs €0.1 million, PD-L1 testing €0.3 million, oncologist/pulmonologist/nurses €0.2 million, radiology €0.06 million and transportation €0.4 million. Savings due to avoided present second-line therapy was calculated €0.4 million. Consequently, the cost of implementing pembrolizumab was €5.5 million and the annual budget impact was €5.0 million. A mean gain of at least 9 months per patient treated was necessary to make pembrolizumab cost-effective.ConclusionsThe net budget impact of pembrolizumab was €5.0 million. The expenditure could not be indicated cost-effective. Price confidentiality is a growing problem in health economics and it has become a ‘menu without prices’ setting.

A microsimulation model to assess the economic impact of immunotherapy in non-small cell lung cancer

“…Therefore, indirect costs might be reduced through a lower burden on informal caregivers and return to work for some patients. Our results are consistent with the study by NORUM et al [11], who estimated the annual budget impact in Norway to be €5 million for 105 NSCLC patients treated with pembrolizumab as a second-line therapy.…”

“…However, these new agents are extremely expensive [7][8][9][10], and nationwide data on budget impact are scarce. We identified only one study that showed 105 NSCLC patients per year would be eligible for anti-PD-1 treatment in Norway, with an annual budget impact amounting to €5 million [11]. However, only 2500 new NSCLC cases are diagnosed each year in Norway and this study was limited to pembrolizumab as second-line therapy for NSCLC.…”

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“…Of the 35 publications remaining, 15 were further eliminated; eight were unpublished abstracts and five were review articles. Two publications were ultimately removed owing to non-modeling and/or non-comparative designs that evaluated cost but not specifically CE [ 23 , 24 ]. Thus, 20 original investigations were found to have sufficient focus and relevance to be incorporated into the systematic review.…”

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