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Background and Importance Nivolumab was the first anti-PD-1 drug to be marketed, marking a significant advancement initially in the treatment of melanoma and non-small-cell lung cancer. Since then, anti-PD-1 therapies have revolutionised cancer treatment. The hospital use of nivolumab continues to increase and optimising dosing strategies to reduce costs while maintaining efficacy can play an important role in supporting the sustainability of the healthcare system.Aim and Objectives To evaluate the economic impact, measured in direct costs, of using reduced dose nivolumab for the treatment of various cancer types.Material and Methods A descriptive observational study was conducted, including 160 patients diagnosed with different types of cancer. These patients were administered nivolumab at a dose of 3 mg/kg instead of the fixed 240 mg dose specified in the drug’s summary of product characteristics. All patients prescribed reduced dose nivolumab were included, regardless of the number of cycles received.Results Weight-based dosing of nivolumab during the study period resulted in a total direct cost saving of €345,826. Per patient savings ranged from €39 to €16,551. By cancer type, patients treated with nivolumab at 3 mg/kg included: 13 with head and neck cancer, four with oesophageal cancer, 10 with gastric cancer, 39 with melanoma, 45 with non-small-cell lung cancer, 41 with renal cancer, seven with urothelial bladder cancer, and one with Hodgkin’s lymphoma. Reduced dose nivolumab was prescribed in 100% of the cases during the study period. No reduction in treatment efficacy was observed in patients receiving nivolumab at 3 mg/kg.Conclusion and Relevance Administering nivolumab at 3 mg/kg represents an efficient dosing strategy, resulting in substantial cost savings without compromising patient outcomes. This has significant implications for the sustainability of the healthcare system, particularly in oncology, where therapeutic innovation is rapidly evolving.Conflict of Interest No conflict of interest