OBJECTIVES:

In France, seven anti-PD(L)1 drugs are marketed. The number of authorized indications has increased significantly in recent years (pembrolizumab: 21 today). Some anti-PD(L)1 drugs share strictly identical indications or share only part of an indication. To control health spending, our department provides health economics synthesis for Paris University Hospitals (AP-HP) prescribers, to make them aware of the high cost of treatments. The objectives of this study are to evaluate whether for the same indication the cheapest anti-PD(L)1 drug is prescribed, and to analyse the evolution of spending.

METHODS:

The study focused on pembrolizumab and nivolumab, the two most used anti-PD1 drugs. Drug consumption and spending data were extracted from AP-HP hospitals discharge database between 2017 and 2021, and crossed with indications filled in by prescribers. European public assessment reports (from European Medicines Agency website) and Official Journal of the French Republic publications were used to check authorized and reimbursed indications. Annual treatment costs were calculated with authorized dose, for a 70kg patient.

RESULTS:

A total of 4 indications were shared by the two anti-PD1 drugs: melanoma (strictly the same), monotherapy non-small cell lung cancer (NSLC), kidney cancer and Hodgkin lymphoma. Nivolumab was the most used treatment only for melanoma (145/193 patients), and pembrolizumab for the other three indications (NSLC: 157/212, kidney cancer: 41/71, Hodgkin lymphoma: 14/24). Annual treatment costs per patient is €90,124 for pembrolizumab, €63,357 for nivolumab. For melanoma, between 2017 and 2019, both treatments were used equally, whereas since 2019, prescriptions of pembrolizumab have decrease (110/227 in 2019 versus 48/229 in 2021) contrary to nivolumab (118/227 in 2019 versus 145/229 in 2021).

CONCLUSIONS:

The cheapest anti-PD1 drug seems to be chosen only for the strictly same shared indication. However, use of pembrolizumab in melanoma has been declining since 2015, probably due to the cost difference between the two anti-PD1 drugs.