Abstract
In 2018, dosing regimens of the two most prescribed immune check point inhibitors (ICI), nivolumab (Opdivo®) and pembrolizumab (Keytruda®), in the treatment of lung cancer were changed from weight-based dosing to fixed dosing. The aim of this study was to compare the economic impact of this change in our university hospital group and then across Ile-de-France, the most inhabited French region. A budget impact analysis (BIA) has been performed on the French public health insurance data. The duration of treatment and the weight of the patients were calculated using data from the patients treated at our health facility and from clinical studies. The cost of treatment was calculated at the local level of our health facility and then for Ile-de-France. Our model demonstrates an additional cost of €550,115 in our hospital and €9,704,778 in Ile-de-France for a fixed dose prescription in 2018. In 2019, the BIA concluded an additional cost, according to the respective low and high assumptions, of €556,969 and €756,544 locally and € 10,201,027 to €14,486,141 for Ile-de-France for an equivalent efficacy between the two different drug dosing regimens of nivolumab and pembrolizumab. The adoption of the fixed dose regimen would lead, according to the least expensive hypothesis, to an additional cost of 26% for the ICI. These results encourage reflection on the strict adoption of this dosage modification. The option of maintaining the free choice between a prescription adapted to weight or in a fixed dose seems a relevant option and should be considered.
Highlights
Lung cancer has been the most common cancer in the world for several decades, with 1.8 million cases diagnosed in 2012
A budget impact analysis (BIA) was carried out, The economic impact was measured by evaluating the additional cost generated by the use of a according to the recommendations of the HAS (Haute Autorité de Santé, Paris, France) [21], for the fixed-dose compared to a weight-based dose
At Avicenne Hospital, at the time of the dosage change of nivolumab in April 2018, we observed over the first four months of 2018 that for 77% of the prescriptions of nivolumab for a non-small-cell lung carcinoma (NSCLC), prescribed doses were lower than the fixed dose of 240 mg
Summary
Lung cancer has been the most common cancer in the world for several decades, with 1.8 million cases diagnosed in 2012. Lung cancer is the leading cause of cancer death in France, all populations combined, with 30,991 deaths estimated in 2017 with a median age at the time of death of 68 years for men and 67 years for women. It is the first cause of death among all causes in men between 45 and 64 years old and the second cause of cancer death in women after breast cancer [3]. Advanced non-small-cell lung carcinoma (NSCLC) treatment has been based on cytotoxic chemotherapy for decades, with a doublet of platinum in combination with several others agents [4]
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