Background and importance Different studies have shown the equivalence of the dosage regimen for pembrolizumab adjusted to the patient‘s body weight (DPC: 2 mg/kg/3 week) and the fixed dose (DF: 200 mg/3 weeks), and the equivalence between nivolumab’s DF (240 mg/2 weeks) and its DPC (3 mg/kg/2 weeks).
Aim and objectives To estimate the savings achieved by using DPC up to maximum doses of 200 mg for pembrolizumab, and 240 mg for nivolumab, in a medical oncology service of a third level hospital.
Material and methods A mathematical model was developed that included the cost of pembrolizumab/nivolumab (based on the laboratory’s sales price), as well as the anthropometric characteristics of the patients, to estimate the economic impact using a cost minimisation analysis, on administration of DF versus DPC for oncological patients. All patients who received pembrolizumab for 2 years (2018–2020) and nivolumab for 3 years (2017–2020) were included in the study.
Results A total of 84 individuals were included:
65.5% (n=55) received nivolumab for the treatment of melanoma, (34.5%); non–small cell lung cancer (NSCLC) (23.6%); head–neck carcinoma (23.6%); and other types of carcinomas (18.2%).
34.5% (n=29) received pembrolizumab for the treatment of NSCLC (89.6%) and urothelial carcinoma (10.3%).
The mean number of cycles received was 14.1(2–72) for nivolumab and 11.5(2–32) for pembrolizumab.
During the study period, the use of nivolumab administrated as DF would have cost a total of 3 515 760€ (1 171 920€/year; 63 923€/patient). However, the DPC would have cost 2 994 296€ (998 099€/year; 54 442€/patient), which means an annual saving of 173 821€. The total cost of treatment with pembrolizumab as DF for this study period was 2 374 956€ (1 187 478€/year; 81 895€/patient), while DPC would have had a total cost of 1 625 739€ (812 869€/year; 56 059€/patient), which means an annual saving of 374 608€.
Conclusion and relevance The introduction of immunotherapy in the oncological field has supposed an improvement in the survival of patients, but with a relevant economic impact. The search for strategies of this type can help optimise health resources without compromising the effectiveness of treatments. With the present study, we wanted to show one of these strategies that would allow a saving of 23% (548 429€/year) in the expenditure associated with pembrolizumab and nivolumab.
Conflict of interest No conflict of interest
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