OBJECTIVES: to analyze how health technology assessment (HTA) decisions for new disease conditions impact the prices of drugs already on the market.

METHODS: Pricing and HTA decision data for nivolumab and pembrolizumab from February 2013 – April 2018 were collected for Germany, France, the U.K., and Australia. 121 HTA decisions were analyzed. The price of the drug at the time of decision, the next price change, and the time until the next price change were recorded for each HTA decision. HTA reviews often apply to more than one formulation of a drug, though different formulations are often assigned different prices. Overall, 432 HTA decision/formulation combinations were analyzed.

RESULTS: When HTA agencies reviewed nivolumab for a first disease condition, the drug’s price changed, on average, 5.3 months after the review, compared to an average of 8.8 months for pembrolizumab. This pattern remains when only positive decisions are considered: nivolumab’s price changed, on average, 8.8 months after the first positive decision, compared to 11.1 months for pembrolizumab. The inverse was seen for negative decisions: nivolumab’s price changed, on average, 10.0 months after a negative decision, compared to 8.0 months for pembrolizumab. Similar patterns were observed when the drugs were reviewed for new disease conditions subsequent to their initial disease conditions. The price for nivolumab changed, on average, 3.2 months following a first positive decision for a new disease condition, compared to 4.3 months for pembrolizumab. The magnitude of the price changes for new disease conditions also differed, with an average 11% price decrease for nivolumab compared to a 21% price decrease for pembrolizumab.

CONCLUSIONS: HTA decisions for existing drugs for new disease conditions can have a substantial impact on the prices of those drugs. Understanding the relationship between price and HTA decisions can have important implications for policymakers and industry stakeholders.