Price Evolution of Selected Cancer Immunotherapies in the US and Key European Markets

OBJECTIVES: To study the price evolution of selected PD-1 (programmed cell death-1) and PDL-1 (programmed cell death ligand-1) inhibitors (pembrolizumab, nivolumab, and atezolizumab) in the US, Germany, France, and the UK.

METHODS: First and subsequent list ex-factory prices of selected immunotherapies were retrieved. Percentage price changes in each year relative to the first price were calculated.

RESULTS: The prices of drugs evolved over time with the addition of new indications. Substantial list price erosion over time was seen in Germany and France for all considered drugs (-23-35% vs. initial price), apart from atezolizumab in France (-3% vs. initial price). In the UK, all list prices remained constant over time. A substantial list price increase was observed in the considered time in the US (+17-29% vs. initial price). In France and Germany, the highest drop in prices was observed in the first 1-2 years; after this period, prices stabilized. In the US, prices were increasing by 2-4% every year for all drugs.

CONCLUSIONS: The first list price was the highest across the analyzed period in Germany and France and the lowest in the US. In the UK, the list prices remained constant over time; however, it is likely that confidential discounts have been introduced to decrease net prices. In Europe, the increase in target population size drives a price decrease. It remains to be checked how price erosion depends on the size of the additive population and the effect size observed in this population. In the US, price levels were not dependent on volume, giving manufacturers more incentive to extend indications.