Current Reimbursement Landscape for Re‑Treatment with Anti-PD-(L)1 Agents after Treatment in Early-Stage Cancers: A Payer Survey

Author(s)

Aguiar-Ibáñez R1, Kaliasethi A2, Ferreira D3, Lauer A4, Spiteri C5, Kothari S6, Alleman C7, Mckendrick J8
1Merck Canada Inc, Toronto, ON, Canada, 2Avalere Health, Fleet, HAM, UK, 3MSD Brasil, São Paulo, Brazil, 4MSD, Singapore, Singapore, 5MSD, Macquarie Park, NSW, Australia, 6Merck & Co. Inc., Rahway, NJ, USA, 7Avalere Health, Fleet, UK, 8Avalere Health, Hampshire, HAM, UK

OBJECTIVES:

Current evidence suggests that reintroducing immunotherapy after its discontinuation can benefit selected patients. This study aimed to understand current and anticipated reimbursement policies for retreatment with anti-PD-(L)1s following their use in early-stage cancers.

METHODS:

A survey (informed by a targeted literature review -TLR-) involving 54 payers from France, Germany, Italy, Spain, UK, USA, Canada and Australia, evaluated factors associated with reimbursement decisions for re-treatment with anti-PD(L)1s following their use in early-stage cancers (triple-negative breast cancer, melanoma, non-small cell lung cancer, and renal cell carcinoma).

RESULTS:

Payer responses showed variability in reimbursement of re‑treatment with anti-PD-(L)1s following their use in early-stage cancers in selected countries. Across cancer types, re‑treatment with anti-PD-(L)1s was considered fully reimbursed (according to 24-29% of payers), reimbursed with restrictions (29-37%), or not reimbursed (35-47%). Key themes influencing restricted reimbursement included: disease-free interval length (43%), need to request funding (33%), and tumor-specific (26%) or stage-specific restrictions (24%).

Similar proportions of payers reported full or restricted reimbursement of retreatment after discontinuation due to immune-related adverse events, after a fixed-duration of therapy, and after intervening treatment (73-76%). Across markets, 59-64% of payers reported (restricted) reimbursement for retreatment when discontinuation occurred due to relapse while on treatment.

The main barriers to reimbursing re‑treatment with anti-PD-(L)1s following their use in early-stage cancers were reported to include lack of comparative evidence of clinical benefit (85%), cost/budget-impact (52%), and cost-effectiveness results (39%). Most payers (70%) reported that access challenges would not differ across tumor types; differences, if any, would center on tumor types with more evidence available for retreatment (e.g., melanoma).

CONCLUSIONS:

Reimbursement (with restrictions) with anti-PD-(L)1-based retreatment with anti-PD-(L)1s following their use in early-stage cancers was reported by the majority of payers. Further clinical evidence would be helpful to better inform retreatment funding decisions.

Conference/Value in Health Info

2024-05, ISPOR 2024, Atlanta, GA, USA

Value in Health, Volume 27, Issue 6, S1 (June 2024)

Code

HPR25

Topic

Health Policy & Regulatory

Topic Subcategory

Reimbursement & Access Policy

Disease

Oncology

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