Health outcomes and budget impact projection of anti-PD-(L)1s in cancer care in Portugal.

PD-[L]1 inhibitors revolutionized cancer treatment but challenge the affordability of health systems. This policy-focused model aimed to estimate the health and budget impact of anti-PD-(L)1s in Portugal and inform current discussions. The Health Impact Projection (HIP) model estimates clinical (life years, progression-free survival [PFS] years, and quality-adjusted life years [QALY] gained and adverse events [AEs] incurred) and economic (direct and indirect costs) outcomes in a world where cancer patients are initiating treatment with standard-of-care (SOC) versus SOC plus anti-PD-(L)1s over a 3-year time horizon. Indications included adjuvant and metastatic melanoma, non-small cell lung cancer (first and second line), metastatic triple-negative breast cancer, head and neck cancer, urothelial carcinoma, and renal cell carcinoma. Model inputs were based on publicly available literature data and expert opinion. The model estimated that, over 3 years, 7,773 patients would be treated with anti-PD-(L)1s, realizing a gain of 4,787 life years, 6,901 PFS years, and 4,214 QALYs and avoiding 399 AEs. The introduction of anti-PD-(L)1s had a projected average annual impact of ≈ €108 million and a share of 20% of total cancer medicines expenditure and 0.6% of total healthcare expenditure in 2021. Although higher disease management costs are expected for patients living longer with anti-PD-(L)1s and drug acquisition costs are considerable, that is partially offset by a reduction in end-of-life costs (€611,092/year) and costs associated with patient productivity lost to cancer (€9,128,142/year). This model highlights the significant survival and QoL benefit of anti-PD-(L)1s for cancer patients in Portugal, with a relatively low increased cost in total healthcare expenditure.

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Copyright © 2023 Costa, Alexandre, Mansinho, Sousa, Vieira, Hughes, Roediger, Pereira and Araújo.

Déclaration de conflit d'intérêts

LC participated in advisory boards sponsored by MSD. AM received honoraria as consultant/speaker from Amgen, Astellas, Bayer, B. Braun, Bristol Myers-Squibb, Janssen, Merck-Serono, Merck Sharp & Dohme, Novartis, OM Pharma, Pfizer, Pierre Fabre, Roche, and Servier; travel/logistics support from Amgen, Astellas, Bayer, Bristol Myers-Squibb, Janssen, Merck-Serono, Merck Sharp & Dohme, Novartis, OM Pharma, Pfizer, Pierre Fabre, Roche, and Servier; and research funding from Bayer. RS received honoraria as consultant/speaker from Roche, Merck Sharp & Dohme, Novartis, Pierre-Fabre, Bristol-Myers Squibb, Astrazeneca, Glaxosmith, Lilly, Pfizer, and Tesaro. CV performed consulting or advisory activities for MSD, Bristol-Myers Squibb, Merck Serono, Novartis, F. Hoffmann-La Roche Ltd., Lilly and Grünenthal and received reimbursement for travel expenses from F. Hoffmann-La Roche Ltd., MSD, BMS, Pfizer, and Novartis. RH is an employee of Adelphi Values Ltd. Adelphi Values Ltd. received reimbursement from MSD for the conduct of this study. AR and SP are employees of MSD and may own stock and/or hold stock options in Merck & Co., Inc., Kenilworth, NJ, USA. AA performed consulting/advisory activities for Merck Sharp & Dohme, Bristol Myers Squibb, AstraZeneca, Janssen, Pfizer, IPSEN, Takeda, Boehringer Ingelheim; research funding for Astellas, Janssen; and expert testimony for Merck Sharp & Dohme, Bristol Myers Squibb, AstraZeneca, Janssen, Pfizer, IPSEN, Takeda, and Boehringer Ingelheim. The authors declare that this study received funding from MSD Portugal and MSD International Business GmbH. The funder had the following involvement in the study: funding in model development, contributing with local data and expertise, and commenting on the paper. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.