OBJECTIVES : To perform a budget impact analysis aiming at evaluating the impact of changing nivolumab doses in different cancers in the perspective of a non-vertical health insurance operator in Brazil. Previously, nivolumab doses were modified according to patients’ body weight. However, the current fixed regimens allow for greater dosage convenience with sustained efficacy and safety.

METHODS : This is a quantitative, descriptive study using secondary data extracted from a computerized system of a health insurance company in South Brazil (Paraná). The data refer to the direct costs of patients treated with nivolumab in December 2019. Observations with missing or incorrect values were excluded. Dose modifications and financial impact were evaluated. Prices in reais (R$) were obtained from the Drug Market Regulation Chamber (CMED) of Brazil. Indirect costs were not included in the calculation. Economic analyses were conducted using the Excel® 2010 software.

RESULTS : Overall, 28 patients were identified for analysis with an average weight of 76.9 (± 15.4) Kg. The most prevalent diagnoses were of melanoma (36%), kidney cancer (32%) and lung cancer (21%). The annual cost for treating this population with the variable dosage (3 mg/kg) was R$ 13.547.146,31. If the same patients received the fixed doses of 240mg every 14 days or 480mg every 28 days, the costs would rise to R$ 14.081.488,51, corresponding to an increase of R$ 534.342,20/year. Patients weighing <80kg show a growth in the treatment expenses, while patients weighing ≥80kg lead to avoided costs to the source of payment.

CONCLUSIONS : The new fixed dosage of nivolumab increases treatment costs in the studied population. Since there are no statistically significant differences in efficacy and safety, both dosage options could be included in the medication package insert.