OBJECTIVES : This study examines which outcomes, particularly primary and secondary endpoints, are most influential for payer and prescriber decision-making for non-small cell lung cancer (NSCLC) immune checkpoint inhibitors (ICIs) in France, Germany, Italy, Spain, and the United Kingdom.

METHODS : 51 national and regional EU5 health technology assessments (HTAs) for approved ICIs (nivolumab, pembrolizumab, atezolizumab) from 2016 to 2019 were collected using the Market Access and Global Market Access Solution Platforms by Decision Resources Group. The decisions were analyzed for clinical factors that influenced HTA outcomes. In April 2018, 251 oncologists were surveyed regarding their prescribing patterns, including which clinical and nonclinical outcomes most influence their prescribing. 10 payers who influence HTA nationally or regionally were interviewed.

RESULTS

: 48-58% of oncologists indicated that improvement in overall survival (OS) was the factor that most strongly influenced their choice of ICI for NSCLC, with the strongest influence in the UK (58%). Progression-free survival (PFS) (12-34%) and response (4-16%) were both considered less important to physicians. Factors like frequency of administration, safety and tolerability profile and familiarity with the brands were less influential in impacting prescribing according to physicians surveyed. OS was the most important efficacy factor influencing payer decision-making as well (84% of positive HTA decisions cited the OS outcome in their rationale), with PFS and response endpoints considered less frequently by HTA bodies. The OS, PFS and response preferences of physicians and HTA agencies did not align by country, as German physicians were most influenced by PFS (34%), while only 16% of German HTA decisions considered available PFS data.

CONCLUSIONS : Surveyed oncologists and HTA decisions both cited OS as the most influential factor affecting decision-making for ICIs in NSCLC. However, there was divergence in how influential other endpoints (PFS, different response types, safety and tolerability) were between the agencies and the oncologists practicing in those geographies.