OBJECTIVES: To review all available cost effectiveness studies for Anti-PD1/PD-L1 treatments and develop lessons for policy development for immunotherapies.

METHODS: We identified and reviewed published cost effectiveness analysis for Pembrolizumab, Nivolumab, Atezolizumab, Avelumab and Durvalumab in peer-reviewed journals and Health Technology Assessments (HTAs). Data was collected for: (1) Product (2) Indication (3) Model design and assumptions (4) Author of the analysis (manufacturer, HTA or academic group) (5) Cost effectiveness results and (5) Sensitivity analysis results. All cost effectiveness ratios were converted to 2017 US dollar amounts using historical currency conversion rates.

RESULTS: For five FDA approved Anti-PD-1/PD-L1 therapies, 52 cost effectiveness analyses were identified, of which 50% were authored by academic experts, while 32% and 18% were authored by Merck and BMS. More than half (52%) of the models were partitioned survival models, 35% were markov and others were decision analytic models; 19 models were for United States, 17 for European countries and others for rest of the world. 17 models used lifetime horizon, others used 5-30 years. 21 models were for melanoma, 18 for lung and 9 were for renal cancer. In the base case scenario, in the US the median base case incremental cost effectiveness ratio (ICER) was $224,099 (range: $81,091 to $920,414). In the EU the median ICER was $81,478 (range: $22,546 to $220,921). The lowest ICERs were reported by industry authored analyses. Median ICERs varied by indication: Melanoma $77,349, Lung $125,224, Renal $121,788 and Head and Neck cancer $142,708. While there was a large variation in ICERs, majority (83%) of the publications considered the therapies to be cost-effective.

CONCLUSIONS: Review of cost effectiveness studies for anti-PD-1/PD-L1 therapies shows large variation in methodology and reported ICER values. Majority of the analyses found that anti-PD-1/PD-L1 therapies are cost effective.