Assessing the impact of anti-PD-1/PD-L1 inhibitors on cancer care health and budget in Ireland.
Authors: Iseult Browne, Catherine Weadick, Austin G Duffy, Harriet Doig, Eoin Bradley, Elizabeth Bell, Nirav Nagda, Stefano Lucherini, Aileen Murphy
Journal: Journal of Clinical Oncology (2021)

e13593 Background: In Ireland, the incidence of cancer was estimated to be 30,272 in 2018 with approximately 9,621 deaths. Over the next five years, the incidence of all cancers is expected to increase by 39% in males and 27% in females. Despite chemotherapy being considered the SOC in many malignancies, it is associated with high levels of toxicity. The introduction of immunotherapy in oncology has revolutionized cancer care, offering improved health outcomes in a range of tumor types. Many treatment options with the potential for use in several cancer types has led to concerns around the long-term affordability of these products. The objective of the study is to estimate and inform current discussion around the potential public health and economic impact of PD-1/PD-L1 inhibitors in Ireland. Methods: The Health Impact Projection (HIP) model estimates the key clinical health and economic outcomes of PD-1/PD-L1 inhibitors in eight high incidence cancers, over a five-year period (2020–2024) compared to the SOC treatments. SOC includes chemotherapy, immuno-oncology treatments not part of the anti PD-1/PD-L1 class (e.g. ipilimumab) and radiotherapy. It includes an assessment of the relative health benefits such as life-years gained, and utility-adjusted life years gained while drawing on budget impact analysis for its structure and methods. The HIP compares the economic and health outcomes in two scenarios; a world without anti PD-1/PD-L1 treatments, to those obtained in a world where patients are treated with a mix of SOC and anti PD-1/PD-L1 treatments. Results: The model shows that over five years, the clinical benefits offered by the introduction of anti PD-1/PD-L1s include an additional 3,194 life-years, 2,411 progression-free life years, 2,638 quality-adjusted life years and the avoidance of 92 adverse events. PD-1/PD-L1 inhibitors produce an average annual budget impact that is equivalent to 0.32% of total healthcare expenditure. Amongst this figure is a reduced burden of indirect costs and end of life costs – both of which fall with anti PD-1/PD-L1s on the market. Conclusions: Ireland faces uncertainty in cancer care with pressure to reduce costs – the HIP helps demonstrate the value of anti PD-1/PD-L1s. Problems stem from a healthcare system that is fragmented and orientated towards dealing with acute conditions. Anti PD-1/PD-L1s are predicted to improve outcomes in Ireland with PFS gains being the largest. In 2020, the budget impact of this class in Ireland is expected to represent a somewhat significant portion of total expenditure on cancer medicines but a small portion of total healthcare expenditure. By projecting budget impact over a five year period, this model should help inform multi-annual budget planning for innovative oncology medicines. This model informs planning by helping quantify the impact of immuno-oncology treatments on health and budget in different scenarios.