Immunothérapie : une innovation de rupture non soutenable économiquement ?

The arrival of new immunotherapy anticancer drugs on the market marks a turning point. Their reference prices are fixed in the US and are positioned at the same level that the anticancer targeted therapies. They benefit from an accelerated approval process and often obtain the status of orphan drugs. The extensions of indications to many cancers and the likely combinations could significantly increase healthcare spending at a level that recently unveiled their non-sustainability, due to unrealistic prices approved by regulators. The current model of regulation needs to be revamped. HTA (Health Technology Assessment) could represent an appropriate response but face strong resistance especially because it would introduce a comparative assessment based on cost effectiveness with the greatest impact on prices of anticancer drugs. Market deregulation, allowing decentralized bargaining, could benefit from the transformation of the administered price into a maximum ceiling price. Two social bodies will have a great responsibility to influence policies that will necessarily be adjusted on a short term. The oncologists will be faced with difficult choices if they avoid the challenging debate on prices: they will be forced to accept rationing at the risk of being confronted with contradictory demands and a cognitive dissonance; they may also, following ASCO, accept that the increased co-pay and its “financial toxicity” represents a new drug side effect integrated in the medical decision process. The engagement of patients' associations will be equally decisive.