OBJECTIVES: Cabozantinib is approved for first-line and second-line advanced-renal-cell-carcinoma (RCC) and second-line advanced-hepatocellular-carcinoma (HCC). However, for a multi-indication medicine, the scale of patient benefit may vary significantly between indications, as would its value-for-money if there is a single, fixed price. We aimed to leverage the cost-saving (CS) generated by introducing Cabozantinib in Algeria, to get payers’ value recognition at indication level and support access for the three indications.

METHODS: A budget impact model (BIM) was developed to evaluate the potential BI of cabozantinib applied in three indications, from payer perspective in Algeria, over 5-year time horizon, by comparing annual costs of cabozantinib with alternative therapies and determining cost-components’ weights for each indication among BI scenarios.

RESULTS: Cabozantinib generated a CS of 101 543€ over 5-years; treatment is the main CS driver covering 74,6% of total BI compared to other cost-components. RCCL1 & RCCL2 generated the highest CS (73 325€ over 5-years); treatment-cost covers 78,83% of total BI. HCCL2 generated CS of 28 217€ over 5-years. At year-5, treatment-costs’ weights are decreasing for RCCL1 (From 90,56% to 58,56%) and HCCL2 (from 65,78% to 45,71%) while increasing for RCCL2 (92,93%). Post-progression and adverse-events management-costs’ weights become substantial for HCCL2 at year-5 (60,86%), while neutral to negative for RCCL1 & RCCL2 at year-5.

CONCLUSIONS: The introduction of Cabozantinib as treatment option for the three indications in Algeria may achieve a substantial total budget saving (2.5% of national oncology budget while RCC & HCC are ranked twentieth), which is mainly driven by drug-price according to Algerian pricing guidelines. Due to differences in target populations, median-overall-survival, median-progression-free-survival and response-rates, the generated CS is more important for RCC vs HCC and cost-components’ weights vary between indications over-time. This provides payers with evidence-based information supporting negotiation processes tailored to specific patient populations, through indication-based and/or weighted-average pricing payment-models (Innovative contractings-models).