Background A Therapeutic Positioning Report published by the Spanish Agency for Medicines and Healthcare Products concludes that there are no differences in efficacy and safety between nivolumab, pembrolizumab and atezolizumab for patients with lung cancer and PD-L1 expression >1%. The treatment must be chosen according to efficiency criteria.
Purpose To perform a cost-minimisation analysis and a simulation on the real population.
Material and methods For the cost-minimisation analysis, the price of atezolizumab, nivolumab and pembrolizumab were used, taking into account discounts and VAT (€2312.63/vial of 1200 mg, €838.86/vial of 100 mg, €1931.696/vial of 100 mg, respectively). The cost of treatment/day (CTD) was calculated for each alternative: atezolizumab 1200 mg/21 days; nivolumab 3 mg/kg/14 days and fixed doses of 240 mg/14 days for weight >80 kg; and pembrolizumab 2 mg/kg/21 days and pembrolizumab fixed dose of 200 mg/21 days. The costs were calculated for the range of 55–95 kg. A simulation to patients with nivolumab treatment from April 2016 to July 2018 was performed. The CTD and total treatment cost were calculated up to the time of analysis for each patient according to weight and number of cycles received, for the alternatives nivolumab and atezolizumab. The difference in cost per treatment was measured.
Results The CTD was: atezolizumab=€110.13, pembrolizumab 200 mg/21 days=€183.97, pembrolizumab 2 mg/kg=€91.99–€174.77, and nivolumab 3 mg/kg=€89.88–€143.80, remaining fixed for >80 kg. The difference in cost benefits of nivolumab up to 61.3 kg, weight for which the cost was equal. Twenty patients were treated with nivolumab during the study period. The average weight of the patients was 82 kg (range 52–100 kg). Eighty-nine per cent of the administrations were to patients over 61.3 kg. They received an average of four treatment cycles and a total of 100 administrations. The average CTD was €132.95 for nivolumab with a total cost of €285.191. The use of atezolizumab instead of nivolumab, would have entailed a total cost of €231.263 (€53.298 less or −19%).
Conclusion At current prices, atezolizumab is more efficient than nivolumab when the patient’s weight is above 61.3 kg. In our population, with a much higher average weight, the use of atezolizumab instead of nivolumab would have meant a reduction of one-fifth in the costs of treatment.
References and/or acknowledgements https://www.aemps.gob.es/medicamentosUsoHumano/informesPublicos/docs/IPT-atezolizumab-Tecentriq-cancer-pulmon.pdf
No conflict of interest.
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