Presentation (CTI)

OBJECTIVES: Novel immunotherapies such as pembrolizumab have transformed cancer treatment and improved survival across multiple malignancies. However, the high costs of pembrolizumab raise concerns about patient access and value within the U.S. healthcare system. To estimate national trends and geographic variation in monthly treatment costs of pembrolizumab across Hospital Referral Regions (HRRs) in the U.S. from 2016 to 2022.
METHODS: We conducted a retrospective observational study of treatment episodes of pembrolizumab and other immunotherapy agents between 2016 and 2022 using commercial claims data from the Health Care Cost Institute among patients diagnosed with breast, lung, colorectal, or prostate cancers. We examined the initial treatment episode, defined as the first 30-day period following the first observed receipt of treatment. 30-day cost included total allowed costs paid by the insurer plus patient out-of-pocket spending. Analyses assessed geographic variation in 30-day costs across HRRs.
RESULTS: The mean monthly cost of pembrolizumab was $32,059, with substantial geographic variation (Coefficient of Variation [CV]: 31%). HRR-level monthly costs ranged from $22,543 (10th percentile) to $43,534 (90th percentile), corresponding to a 90th-to-10th percentile ratio of 1.9. Mean costs were similar across cancer types ($30,495 for colorectal cancer, $31,216 for lung cancer, and $33,589 for breast cancer). Geographic variation was greatest in colorectal cancer (CV: 49%), although breast and lung cancers also demonstrated considerable dispersion in monthly costs across regions (CV: 40% and 39%, respectively). From 2016 to 2022, mean monthly costs for pembrolizumab remained consistently higher than those for other immunotherapies.
CONCLUSIONS: Pembrolizumab costs remained consistently higher than other immunotherapies and increased over time. Monthly pembrolizumab treatment costs varied substantially across HRRs, with particularly high variability in colorectal cancer. These findings suggest that regional reimbursement practices and market dynamics may contribute meaningfully to cost dispersion. Addressing regional variation may improve affordability, promote geographic equity, and enhance value in oncology drugs.