OBJECTIVES: Therapeutic cancer vaccines are an emerging and promising type of immunotherapy. One example is V940 investigated in combination with pembrolizumab for the adjuvant treatment of patients with resected high-risk stage 3 melanoma. Cancer vaccines may soon enter the market and provide a step-change in the care for patients with solid tumors, coinciding with patent expiration for some current immune checkpoint inhibitor (ICI) therapies which currently represent standard of care.

This case study explored the cost-effectiveness of V940 plus pembrolizumab contingent on market entry pre- and post-patent expiration of ICIs (and hence expected availability of generic treatments).

METHODS: A lifetime partitioned survival model was developed leveraging a published model in the US setting. Pembrolizumab monotherapy was modelled in line with its license and pivotal trial, KEYNOTE-054, at $22,674 per dose. V940 in combination with pembrolizumab was modelled in line with the V940 phase 3 trial, V940-001. A hazard ratio (HR) was applied to pembrolizumab survival curves to estimate V940 efficacy. The HR was varied to evaluate cost-effectiveness under an assumed market entry a) prior to pembrolizumab patent expiration (list price) and b) after pembrolizumab patent expiration (90–99% discount representing availability of generics), with a willingness to pay threshold of $100,000.

RESULTS: At pembrolizumab list price, a HR=0.73 would be required for V940 to be cost-effective at an equal cost per dose of pembrolizumab. Assuming HRs are aligned with indicative data from the KEYNOTE-942 trial, V940 can achieve a price premium of 8% per dose. Reductions in the price of pembrolizumab improve cost-effectiveness estimates for V940.

CONCLUSIONS: If V940 is priced similarly to pembrolizumab at list price, preliminary analyses indicate cost-effectiveness is achievable. As V940 is a combination therapy with pembrolizumab, price reductions in pembrolizumab improve cost-effectiveness. Further data when available from V940-001 are required to increase the reliability of this study.