PCN122 - DRIVERS FOR DIFFERENT TREATMENT COST ESTIMATIONS ACROSS HTA BODIES

Abstract

Our research aims to highlight the variation in methodologies for vial-based product cost calculations in Health Technology Assessment in Canada (CADTH), Germany (G-BA), Spain (AQUAS) and the UK (NICE). To best showcase how the cost of treatment (COT) is being captured by the various HTA bodies, melanoma was selected as indication. Ipilimumab, nivolumab and pembrolizumab were used as examples to apply different calculations: CADTH’s COT methodology assumes no wastage, while NICE and AQUAS base their calculations including wastage on a single vial presentation. G-BA assumes wastage with a combination of different vial sizes. For the annual COT calculation, cost per mg along with loading dosing (LD) and maintenance dosing (MD) were taken into consideration as well as the LD and MD frequency and duration. For the calculations including wastage with vial combination, we also took different vial sizes that could reach the required dosage into consideration. The calculations were based on an average weight of 75kg. List prices, adjusted for purchasing power parity were the basis of calculations, as well as an assumed price constant across countries to isolate methodological differences. Relative to Canada (no wastage), based on different methodologies only, COT was up to 10% higher in Germany; 25 to 44% in Spain and the UK, respectively. When list prices were taken into consideration differences in COT increased dramatically: Estimated ipilimumab treatment was the most expensive in Spain and United Kingdom, surpassing the COT in Canada by more than 110%. On top of differences based on calculation methodology, list price differences increased overall COT variation by 20% to 98%. Variations in outcomes of cost-effectiveness analysis could derive from the different methodologies and assumption incorporated. Thus, incorporation of real world evidences on wastage and usage could help implement more realistic and aligned calculations and analysis.