OBJECTIVES: The advent of immunotherapy significantly changed the therapeutic scenario of cancer patients. The adoption of immune checkpoint inhibitors (ICIs) represented the new weapon for cancer treatment in different settings. The aim of this study was to describe trends in ICI utilization and corresponding healthcare expenditures within the Italian population.

METHODS: We analyzed IMS-Health National data to describe trends in total number of claims, total annual expenditures, and expenditures per claim for ICIs from January 2017 to December 2022 among Italian population (~60 million inhabitants) (PRIN2017 Prot.2017NR7W5K). Seven market approved ICIs in Italy were analysed (Ipilimumab, Nivolumab, Pembrolizumab, Durvalumab, Avelumab, Atezolizumab, Cemiplimab). A time-series modeling was used for analysis.

RESULTS: From 2017 to 2022, utilization rates for each of the seven market approved ICIs in Italy increased 15.1%, from 215,441 to 614,510 unit-per-year, also overall expenditure on ICIs increased 16.3%, from €236,322,360 to €778,745,480. In the first three-year period analyzed, Nivolumab recorded higher rates of consumption and spending than the other ICIs with a sharp decrease in the following years (-57.1% consumption and -46.6% spending). Opposite trend was recorded for Pembrolizumab with a slow increase in consumption (+38.9%) and spending (+29.0%) over the whole time period.

CONCLUSIONS: The rapid increase in the use of ICIs has accounted for a disproportionate share of the growth in public pharmaceutical consumption and spending in Italy. Future research should relate patient outcomes to overall spending to justify the long-term investment in the use of these therapies for the Italian health service.