OBJECTIVES

In France, hospital drugs are reimbursed only for indications of the marketing authorization (MA) that have been assessed as having a medical interest. Off-label uses are also reimbursed if they are scientifically justified. The uses of anti-PD1 drugs (nivolumab, pembrolizumab) are closely monitored by the authorities due to the high treatment costs (€68,530-91,375 per patient per year) and the number of indications under development. In 2017, nivolumab was reimbursed in melanoma, non-small cell lung cancer (NSCLC) and renal carcinoma (RC) (2017/12) and pembrolizumab was reimbursed in melanoma (2017/01) and NSCLC (2017/05). The objectives of this study are to evaluate the costs and the distribution of the uses of anti-PD1 drugs (MA reimbursed; off-label) in the public hospitals of Paris (AP-HP).

METHODS

Analysis of data on anti-PD1 drugs available on e-PMSI (French Hospital National Database) since their first registrations for reimbursement: consumptions, costs, ICD10 diagnosis of the related hospital stays.

RESULTS

Anti-PD1 drugs were used in 15/37 hospitals of the AP-HP in 2017 (Jan-Nov) for a total cost of €25,059,345 (68% for nivolumab). According to ICD10 diagnosis, 6,531/7,680 hospital stays (85%) were associated with a reimbursed MA indication (1% for NSCLC and 16% in melanoma for pembrolizumab; 55% in NSCLC, 22% in melanoma and 5% in RC for nivolumab). The 5 most frequent ICD10 diagnosis associated with off-label uses were: other and unspecified malignant neoplasm of skin (16%); Hodgkin lymphoma (14%); secondary malignant neoplasm of other and unspecified sites (9%); secondary malignant neoplasm of respiratory and digestive organs (5%); malignant neoplasm of bladder, unspecified (5%).

CONCLUSIONS

It seems that the prescribers of the AP-HP have been properly made aware of the appropriate use of the anti-PD1 given that the prescriptions of these innovative and expensive drugs are made in the indications both authorized and reimbursed.