OBJECTIVES: In France, efficiency of each new eligible treatment compared to standard therapeutic strategies is evaluated before market launch, but rarely after. If immunotherapies have considerably changed the advanced cancer treatment landscape, few information is available on survival benefits at the population level. The objective was to retrospectively evaluate the public health impact of immunotherapies compared to their comparators.

METHODS: Analysis was restricted to immunotherapies with French efficiency opinions (EOs) published by the Haute Autorité de Santé until June-20 without methodological reservation on modeling. Date of treatment availability was retrieved, whereas number of treated patients per indication was identified based on the French hospitals reimbursement database. From EOs, utilities for each treatment and indication were collected. Extrapolated curves of immunotherapies and their comparators were digitized. Cumulative deaths avoided, life years (LY) and quality-adjusted life years (QALYs) gained thanks to immunotherapies were calculated from their introduction until Dec-2020.

RESULTS: Overall, 16 EOs were retained corresponding to 3 drugs (atezolizumab, nivolumab and pembrolizumab) and 4 tumor types: lung cancer (LC; n=9), melanoma (MEL; n=2), renal cell carcinoma (RCC; n=3) or squamous cell head and neck cancer (SCCHN; n=2). In the study period, 111,793 patients initiated an immunotherapy in LC (72%), MEL (12%), RCC (9%) or SCCHN (7%). In total, 12,888 deaths were avoided with immunotherapies, mostly in lung cancer (74%). We observed 23,808 additional LY and 18,372 QALYs. LC was the driver indication with 72% of LY and 70% QALYs gained followed by MEL with 19% and 21% of the gain respectively. Early access participated to 14% of deaths avoided, 36% of LY and 35% of QALYs gained. Nivolumab contributed in 71% of LY and 69% of QALYs gained.

CONCLUSIONS: Significant gains in LYs and QALYs were observed in France thanks to immunotherapies introduction. Early access, when possible, is a real opportunity for patient extended survival.