Elsevier

ESMO Open

Volume 6, Issue 4, August 2021, 100198
ESMO Open

Original Research
Cost-effectiveness analysis of the use of immunotherapy in metastatic solid tumours in Austria by applying the ESMO-Magnitude of Clinical Benefit Scale (ESMO-MCBS) version 1.1

https://doi.org/10.1016/j.esmoop.2021.100198Get rights and content
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Highlights

  • Most European Medicines Agency-approved ICIs have an ESMO-MCBS with significant clinical benefit.

  • In hard-to-treat types of cancer such as TNBC or SCLC, the ESMO-MCBS is <4.

  • Under a willingness-to-pay threshold of €100.000, they do not have a cost-effective comparative benefit in Austria.

Background

Immune checkpoint inhibitors (ICIs) treatment is a breakthrough in managing metastatic solid tumours, but its use is associated with a high financial burden for public health care systems. Validated tools such as the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS) are frameworks that might help to better assess the clinical benefit of these novel innovative cancer drugs.

Methods

Here, we systematically analysed the number of European Medicines Agency-approved ICIs labels with an ESMO-MCBS grade <4 and the impact of the ICIs on incremental costs, gain of life years (LYs), quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio in the Austrian population.

Results

Of 23 ICIs treatment settings, we identified three clinical scenarios in metastatic solid cancers with an ESMO-MCBS grade <4 with no otherwise approved alternatives. In triple-negative breast cancer (TNBC), the addition of first-line atezolizumab increased QALYs by 0.33 compared with nab-paclitaxel only, with an incremental cost per QALY of €143 853. In small-cell lung cancer (SCLC), the addition of first-line atezolizumab increased the QALY by 0.09, with an incremental cost per QALY of €373 256, and the addition of first-line durvalumab increased the QALYs by 0.11, with an incremental cost per QALY of €589 527.

Conclusions

Overall, most of the approved ICIs carry significant clinical benefit (≥4). Although TNBC and SCLC are challenging treatment scenarios, currently approved ICIs with an ESMO-MCBS grade <4 substantially increase the cost of medical treatment, and under a willingness-to-pay threshold of €100 000, they do not have a cost-effective comparative benefit.

Key words

immunotherapy
costs
ESMO-MCBS
Austria

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