Objectives: With KEYNOTE-189 and KEYNOTE-21G trials showing improved overall survival (OS) and progression free survival (PFS) using Pem+Pembro+Plat for initial treatment of patients with metastatic NSQ NSCLC with no EGFR or ALK aberrations, a cost-effectiveness analysis of Pem+Pembro+Plat is needed to enable value-driven decisions. Methods: An area under the curve model comprising four health states: responding, stable, progressed, and dead, was developed to evaluate cost-effectiveness of Pem+Pembro+Plat vs. pemetrexed plus platinum chemotherapy (Pem+Plat). The primary outcome measure was cost per life year (LY) incremental cost-effectiveness ratio (ICER). Clinical effectiveness was parameterized using the published KEYNOTE-189 OS, PFS, and response data. Four survival curves were fitted to the trial data: exponential (best fitting), Weibull, log-normal, and log-logistic. Modeled costs included acquisition, infusion, adverse event, monthly disease state, one-time progression, and death. One-way and probabilistic sensitivity analyses (PSA) were performed on survival curves and cost inputs. Cost-effectiveness of subgroups defined by programmed death-ligand 1 (PD-L1) tumor proportion score (TPS) was analyzed. Costs and LYs were discounted at 3% per annum.
and B-ALL (standard chemotherapy, HSCT, blinatumomab, tisagenlecleucel, and combinations). All studies employed decision analytic models including Markov cohort (n=2), microsimulation (n=3), or partitioned survival (n=2). Median (range)
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