FUNDING OF IMMUNOTHERAPY CHECKPOINT INHIBITORS FOR THE TREATMENT OF ADVANCED OR METASTATIC CANCER IN AUSTRALIA: UNLOCKING ACCESS...
Author(s)
Greg Cook, PhD1, Hansoo Kim, BSc, MSc, PhD2.
1Health Economics and Health Technology Assessment, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia, 2Bond University, Robina, Australia.
1Health Economics and Health Technology Assessment, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia, 2Bond University, Robina, Australia.
OBJECTIVES: Cancer remains the leading cause of death worldwide (WHO). In Australia, access to immune checkpoint inhibitors (ICIs) via the government-subsidised Pharmaceutical Benefits Scheme (PBS) has previously been determined on an indication-by-indication basis through cost-effectiveness evaluation. This framework has shaped, and in some cases constrained, the breadth of ICI access for Australian patients with solid tumours. However, a recent innovative funding decision has marked a significant departure from the conventional model, fundamentally altering the decision-making landscape and unlocking broader patient access. This study examines how ICI funding has evolved in Australia.
METHODS: This narrative review draws on a mix of sources including prescription volumes, government expenditure data, policy documents, and public summary documents pertaining to ICI reimbursement decisions.
RESULTS: In Australia, ICIs accounted for more than AU$1.8 billion in government expenditure in 2024/25, representing approximately 10% of the total PBS budget. Nine ICIs are currently listed on the PBS for the treatment of more than 20 solid tumour types. Since the first listing of ipilimumab in 2013, more than 100 submissions have been made, with pembrolizumab (50 submissions) and nivolumab (46 submissions) leading. The vast majority of submissions have included a formal economic evaluation. A recent agreement between the sponsor of nivolumab and ipilimumab has resulted in both ICIs becoming available on the PBS for the treatment of immunotherapy-sensitive advanced or metastatic cancer. This volume-based agreement is designed to empower treating clinicians and covers current PBS listings, future indications, rare cancers, and ICI retreatment. Other ICIs are expected to follow.
CONCLUSIONS: This pragmatic solution of enabling government-subsidised ICI access for patients with advanced or metastatic cancer not only reduces the burden on the HTA evaluation system but critically unlocks access for a much broader patient population.
METHODS: This narrative review draws on a mix of sources including prescription volumes, government expenditure data, policy documents, and public summary documents pertaining to ICI reimbursement decisions.
RESULTS: In Australia, ICIs accounted for more than AU$1.8 billion in government expenditure in 2024/25, representing approximately 10% of the total PBS budget. Nine ICIs are currently listed on the PBS for the treatment of more than 20 solid tumour types. Since the first listing of ipilimumab in 2013, more than 100 submissions have been made, with pembrolizumab (50 submissions) and nivolumab (46 submissions) leading. The vast majority of submissions have included a formal economic evaluation. A recent agreement between the sponsor of nivolumab and ipilimumab has resulted in both ICIs becoming available on the PBS for the treatment of immunotherapy-sensitive advanced or metastatic cancer. This volume-based agreement is designed to empower treating clinicians and covers current PBS listings, future indications, rare cancers, and ICI retreatment. Other ICIs are expected to follow.
CONCLUSIONS: This pragmatic solution of enabling government-subsidised ICI access for patients with advanced or metastatic cancer not only reduces the burden on the HTA evaluation system but critically unlocks access for a much broader patient population.
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
HPR4
Topic
Health Policy & Regulatory
Topic Subcategory
Reimbursement & Access Policy
Disease
SDC: Oncology