OBJECTIVES : The therapeutic landscape of lung cancer is changing rapidly due to better characterization of non-small cell lung cancer (NSCLC) genetics and identification of hallmark immunobiological characteristics. Although combination immunotherapy agents are increasingly used to achieve better health outcomes, the societal challenges that the combination immunotherapies bring are becoming evident, specifically when their price tags result in reimbursement or payment hurdles in many health systems worldwide. In this study, we aim to assess the valuation and pricing of immunotherapy agents when used in combination with existing treatments in NSCLC.

METHODS : A clinical search was conducted using the US Food and Drug Administration, European Medicines Agency and ClinicalTrials databases to identify combination immunotherapy drugs in NSCLC. An economic evaluation search was conducted, using MEDLINE, the Cost Effectiveness Analysis Registry and Health Technology Assessment databases, to investigate valuation and pricing of combination immunotherapy drugs in NSCLC.

RESULTS : We identified four phase III trials (IMPower150, IMPower131, KEYNOTE-407, and CheckMate 227) which resulted in the approval of atezolizumab with chemotherapy plus bevacizumab, pembrolizumab in combination with chemotherapy, and nivolumab plus ipilimumab in the first-line setting. Favorable economic analyses of these immunotherapies are dependent on the condition that the health benefits of combination immunotherapies justify their costs. In the absence of this justification, risk-sharing agreements and price negotiations are practical. Indication-specific pricing, where the value of a drug is indication-dependent, remains an area for research.

CONCLUSIONS : Challenges associated with value assessment and pricing of combination immunotherapies are evident in NSCLC. Increased stakeholder collaborations (regulatory, academia, industry, government) and future research in novel pricing and payment methods may help leverage resources to achieve sustainable health systems worldwide. Value assessment frameworks that consider broader value dimensions could also be an area of investigation, specifically for combination immunotherapies, and for the assessments where an immunotherapy is not deemed cost-effective at zero price.