OBJECTIVES: Immuno-oncology (IO) therapies have revolutionized treatment in oncology but have led to increased treatment costs for payers and patients. This study explores evolution of cost of treatment over the years for IO drugs in select advanced/metastatic solid tumours.

METHODS: This study included FDA approved IO-based regimens for melanoma, renal cell carcinoma (RCC), urothelial carcinoma (UC), and hepatocellular carcinoma (HCC) in the US. Cost of treatment was estimated for each approved IO-based regimen by multiplying their wholesale acquisition cost from NAVLIN and RED BOOK databases with median duration of treatment as reported from respective clinical trials. In addition, we have reported cost per progression-free life months (PFLM) using the median progression-free survival data reported for each regimen from their clinical trials. Cost of treatment and cost per PFLM were estimated from the year of approval through 2023 or the year of withdrawal of approval.

RESULTS: FDA has in all approved 5 IO drugs for UC (8 indications), 5 for HCC (5 indications), 5 for melanoma (9 indications) and 4 for RCC (6 indications) for use as monotherapy or in combination. Drug costs for a course of treatment increased from $55K-156K in 2018 to $64K-$318K in 2023 in melanoma, from $44K-$55K to $64K-$217K in HCC, from $76K-$145K to $86K-$629K in RCC and from $35K-$50K to $43K-$326K in UC. The cost per PFLM in the corresponding periods were $9K-$49K and $11K-$57K in melanoma, $11K-$20K and $13K-$46K in HCC, $12K-$16K and $14K-$38K in RCC, and $12K-$26K and $14K-$30K in UC.

CONCLUSIONS: Drug costs for a course of treatment with IO therapies have increased over the years due to availability of combination IO treatments. While this has resulted in better outcomes, cost per PFLM has also increased suggesting cost increases have outpaced improvement in outcomes.