Abstract 1335P
Background
Significant survival benefit is seen with pembrolizumab monotherapy for untreated PD-L1-positive metastatic non-small-cell lung cancer and palbociclib for previously untreated, hormone receptor-positive, HER-2 negative, locally advanced, or metastatic breast cancer. However, access and affordability of these drugs remain challenging in low middle-income countries, including India. To improve the access to meaningful treatment options, India’s health insurance scheme, AB-PMJAY, has linked the oncology packages to National Cancer Grid (NCG) resource-stratified guidelines. The survival benefit with these drugs in two of the most prevalent cancers made it relevant to conduct cost-effectiveness (CEA) assessment for their inclusion in NCG guidelines to guide health benefit packages.
Methods
International HTA evidence was leveraged to accelerate the assessment of these drugs by applying an aHTA approach. We developed a scope for the aHTA by defining the population, intervention, and comparator, followed by a rapid literature review for efficacy, safety, and cost-effectiveness data. Subsequently, a price-benchmarking analysis was undertaken to understand the price being paid in India as compared to international prices in selected countries where the medicines are licensed/reimbursed after adjusting for purchasing power parity (PPP). These data were used to estimate treatment cost per year.
Results
There was sufficient evidence on the safety and clinical effectiveness for both the drugs. The evidence for cost-effectiveness supported the recommendation of palbociclib use in the benchmarking countries only after significant price discounts. However, there was only limited CEA evidence on the value for money for pembrolizumab. The PPP-adjusted list prices of palbociclib and pembrolizumab in India were four times and 2-3 times, respectively as compared to other benchmarking countries. The yearly cost of treatment for all eligible patients was estimated to be $2606,567,040 for palbociclib and $3,740,340,100 for pembrolizumab.
Conclusions
As per aHTA, pembrolizumab and palbociclib are not cost-effective in India at the current prices for the assessed clinical indications.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Tata Memorial Centre on behalf of National Cancer Grid.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.