OBJECTIVES

An increasing number of anti-cancer medications are indicated for multiple tumors. Therefore, the overall value of medications provided for all the indicated patients is of great interest to payers. However, the majority of existing pharmacoeconomic evaluations examine the cost-effectiveness of singular indications for multi-indication anti-cancer drugs. The present study aims to take a holistic approach to evaluate the cost-effectiveness of a novel targeted therapy (pembrolizumab) across 5 indications using published Norwegian data.

METHODS

Pembrolizumab is currently indicated for advanced melanoma, 1L&2L NSCLC, and 1L&2L bladder cancer. The economic value of pembrolizumab has been evaluated or is currently evaluated by the Norwegian Medicine Agency (NOMA) for each individual indication. Based on the published indication-specific cost-effectiveness models, we developed a multi-indication model to evaluate the cost-effectiveness of pembrolizumab among the overall indicated patient population. Both cost and QALYs were aggregated using population weights derived directly from NOMA estimates of assessed indication sizes. The comparators within the model represent the standard of care for respective indications. The model was developed from a third-party payer’s perspective with analyses presented for listing price.

RESULTS

Number of eligible patients for advanced melanoma, 2L&1L NSCLC, and 1L&2L bladder is 215, 724, 466, 147 and 176 in Norway, respectively. The indication-specific cost per QALY of pembrolizumab in kr is 1M, 1.3M, 999K, 795K, and 816K, respectively. Among all the indicated population, the weighted cost per QALY was kr 1M/QALY. The results of sensitivity analyses for other key model parameters were robust.

CONCLUSIONS

A holistic cost-effectiveness model of multi-indication drugs provides HTA bodies a useful tool to evaluate the overarching value of anti-cancer drugs and to alleviate the burden of repetitive appraisals in the era of targeted therapies. Analyses show the cost-effectiveness of pembrolizumab vary across indications due to the differential clinical profiles and demonstrate overall cost-effectiveness across indicated indications in Norway.