Cost-effectiveness of pembrolizumab in combination with chemotherapy versus chemotherapy and pembrolizumab monotherapy in the first-line treatment of squamous non-small-cell lung cancer in the US

Insinga, Ralph P.; Vanness, David J.; Feliciano, Josephine; Vandormael, K.; Traore, Sory Ibrahima; Ejzykowicz, Flavia; Burke, Thomas

doi:10.1080/03007995.2019.1571297

Cited by 62 publications

(124 citation statements)

References 22 publications

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“…The incremental cost‐effectiveness ratio (ICER) for pembrolizumab plus chemotherapy versus chemotherapy was $104,823/quality‐adjusted life year (QALY). This is considered cost‐effective using the World Health Organization threshold of $180,000/QALY but not cost‐effective using the conventional U.S> threshold of $100,000/QALY . The chemoimmunotherapy combination was shown to extend life expectancy in patients with tumor PD‐L1 of 50% or greater, compared with pembrolizumab monotherapy (4.53 vs 2.74 yrs), at an ICER of $147,365/QALY and $118,879/QALY, respectively .…”

Section: Quality‐of‐life and Cost‐effectiveness Considerationsmentioning

confidence: 99%

“…The chemoimmunotherapy combination was shown to extend life expectancy in patients with tumor PD‐L1 of 50% or greater, compared with pembrolizumab monotherapy (4.53 vs 2.74 yrs), at an ICER of $147,365/QALY and $118,879/QALY, respectively . In a cost‐benefit analysis of KEYNOTE‐407, pembrolizumab plus chemotherapy was shown to double the life expectancy versus chemotherapy (3.86 vs 1.91 yrs), with an ICER of $86,293/QALY, meeting the cost‐effective threshold (less than $100,000/QALY) across all PD‐L1 subgroups. Additional investigations are needed to determine the cost‐effectiveness of pembrolizumab monotherapy compared with chemotherapy or pembrolizumab plus chemotherapy …”

Section: Quality‐of‐life and Cost‐effectiveness Considerationsmentioning

confidence: 99%

“…In a cost‐benefit analysis of KEYNOTE‐407, pembrolizumab plus chemotherapy was shown to double the life expectancy versus chemotherapy (3.86 vs 1.91 yrs), with an ICER of $86,293/QALY, meeting the cost‐effective threshold (less than $100,000/QALY) across all PD‐L1 subgroups. Additional investigations are needed to determine the cost‐effectiveness of pembrolizumab monotherapy compared with chemotherapy or pembrolizumab plus chemotherapy …”

Section: Quality‐of‐life and Cost‐effectiveness Considerationsmentioning

confidence: 99%

“…This is considered cost-effective using the World Health Organization threshold of $180,000/ QALY but not cost-effective using the conventional U.S> threshold of $100,000/QALY. 67,68 The chemoimmunotherapy combination was shown to extend life expectancy in patients with tumor PD-L1 of 50% or greater, compared with pembrolizumab monotherapy (4.53 vs 2.74 yrs), at an ICER of $147,365/QALY and $118,879/ QALY, respectively. 67 In a cost-benefit analysis of KEYNOTE-407, pembrolizumab plus chemotherapy was shown to double the life expectancy versus chemotherapy (3.86 vs 1.91 yrs), with an ICER of $86,293/QALY, 68 meeting the cost-effective threshold (less than $100,000/QALY) across all PD-L1 subgroups.…”

Section: Quality-of-life and Cost-effectiveness Considerationsmentioning

confidence: 99%

“…Additional investigations are needed to determine the cost-effectiveness of pembrolizumab monotherapy compared with chemotherapy or pembrolizumab plus chemotherapy. 68 Cost analysis of IMpower-150 showed that patients treated with atezolizumab plus bevacizumab plus chemotherapy have an additional 0.413 QALY and 0.738 QALY versus bevacizumab plus chemotherapy and versus chemotherapy, with an ICER of $568,967/QALY and $516,114/ QALY respectively. 69 This suggests that atezolizumab plus bevacizumab plus chemotherapy is not a cost-effective regimen for nonsquamous NSCLC compared with bevacizumab plus chemotherapy or compared with chemotherapy.…”

Section: Quality-of-life and Cost-effectiveness Considerationsmentioning

confidence: 99%

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Optimizing Patient Outcomes with PD‐1/PD‐L1 Immune Checkpoint Inhibitors for the First‐Line Treatment of Advanced Non–Small Cell Lung Cancer

La‐Beck

Nguyen

et al. 2020

Pharmacotherapy

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The rapidly expanding repertoire of immune checkpoint inhibitors (ICIs) now includes two agents, pembrolizumab and atezolizumab, approved for first‐line treatment of advanced non–small cell lung cancer (aNSCLC) as monotherapy or as part of chemoimmunotherapy. This review summarizes the clinical evidence supporting these indications, with a focus on strategies to optimize patient outcomes. These strategies include patient and tumor factors, adverse‐effect profiles, pharmacokinetic and pharmacodynamic drug interactions, and quality of life and cost‐effectiveness considerations. We performed a systematic literature search of the PubMed, Scopus, and Google Scholar databases, as well as a search of the conference proceedings of the American Society of Clinical Oncology, European Society for Medical Oncology, and American Association for Cancer Research (through August 31, 2019). The addition of ICIs to conventional chemotherapy as first‐line treatment against aNSCLC is now part of the standard of care options. However, even though ICIs may be cost‐effective in patients with aNSCLC, high drug and other associated costs can still be a barrier to treatment for patients. Moreover, the adverse‐effect profiles of ICIs differ significantly from conventional chemotherapy, and some immune‐related adverse effects may have a lasting impact on quality of life. Therefore, in adhering to a patient‐centered model of care, clinicians should be mindful of patient‐ and treatment‐specific factors when considering therapeutic options for patients with aNSCLC. Although the role of the immune system in cancer progression and regression has not been fully elucidated, the full clinical potential of immunotherapeutics in the treatment of cancer likely remains to be unleashed.

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Section: Quality‐of‐life and Cost‐effectiveness Considerationsmentioning

confidence: 99%

Section: Quality‐of‐life and Cost‐effectiveness Considerationsmentioning

confidence: 99%

Section: Quality‐of‐life and Cost‐effectiveness Considerationsmentioning

confidence: 99%

Section: Quality-of-life and Cost-effectiveness Considerationsmentioning

confidence: 99%

Section: Quality-of-life and Cost-effectiveness Considerationsmentioning

confidence: 99%

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Optimizing Patient Outcomes with PD‐1/PD‐L1 Immune Checkpoint Inhibitors for the First‐Line Treatment of Advanced Non–Small Cell Lung Cancer

La‐Beck

Nguyen

et al. 2020

Pharmacotherapy

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Cost-effectiveness of Nivolumab-Ipilimumab Combination Therapy for the Treatment of Advanced Non–Small Cell Lung Cancer

et al. 2021

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Key Points Question Is nivolumab-ipilimumab combination therapy cost-effective as first-line treatment for patients with advanced non–small cell lung cancer compared with platinum-doublet chemotherapy? Findings In this economic evaluation of the cost-effectiveness of nivolumab-ipilimumab combination therapy, a Markov model was designed to simulate patients with advanced non–small cell lung cancer who were receiving either nivolumab-ipilimumab combination therapy or platinum-doublet chemotherapy. In this model, nivolumab-ipilimumab combination therapy was not found to be cost-effective at a willingness-to-pay threshold of $100 000 per quality-adjusted life-year, with an incremental cost-effectiveness ratio of $401 700 per quality-adjusted life-year compared with chemotherapy. Meaning The findings suggest that first-line treatment with nivolumab-ipilimumab combination therapy is not cost-effective at current prices despite clinical trial data indicating that this therapy increases overall survival among patients with advanced non–small cell lung cancer.

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Cost‐effectiveness analysis of pembrolizumab plus chemotherapy with PD‐L1 test for the first‐line treatment of NSCLC

et al. 2020

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Background Pembrolizumab (Pembro) in combination with chemotherapy has been approved for the treatment of pretreated advanced NSCLC in the United States and China for its significant efficacy. However, the cost‐effectiveness is unknown considering Pembro's high price. The impact of programmed death ligand 1 (PD‐L1) test on the cost‐effectiveness is also unknown. The current study assessed the cost‐effectiveness of combination therapy for nonsquamous NSCLC from the United States and China public payers’ perspective. Materials and Methods A literature‐based Markov model was conducted using KEYNOTE‐189 trial data to compare cost and quality‐adjusted life years (QALYs) of three treatment strategies for nonsquamous NSCLC: Pembro‐chemotherapy combination and chemotherapy strategy without PD‐L1 test, and treatment strategy according to their PD‐L1 status. Results In base case analysis, the combination strategy generated an additional 0.78 QALYs and 0.59 QALYs over chemotherapy in the United States and China respectively, resulting in an ICER of $132 392/QALY in the United States and $92 533/QALY in China. In the PD‐L1 ≥1% base case, the ICERs were $77 754/QALY and $56 768/QALY respectively in the United States and China for PD‐L1 test strategy. In the PD‐L1 ≥50% base case, the ICERs were $44 731/QALY and $34 388/QALY respectively in the United States and China for PD‐L1 test strategy. Lowering Pembro price can also partly decrease the ICERs. Conclusion Compared with chemotherapy, the combination strategy is not cost‐effective for the treatment of NSCLC in the American and Chinese health care system at WTP threshold of $100 000/QALY for the United States and $27 351/QALY for China. Using PD‐L1 test for patient selection and price reduction could improve the cost‐effective probabilities of immunotherapy for nonsquamous NSCLC.

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Cost-effectiveness of pembrolizumab in combination with chemotherapy versus chemotherapy and pembrolizumab monotherapy in the first-line treatment of squamous non-small-cell lung cancer in the US

Cited by 62 publications

References 22 publications

Optimizing Patient Outcomes with PD‐1/PD‐L1 Immune Checkpoint Inhibitors for the First‐Line Treatment of Advanced Non–Small Cell Lung Cancer

Optimizing Patient Outcomes with PD‐1/PD‐L1 Immune Checkpoint Inhibitors for the First‐Line Treatment of Advanced Non–Small Cell Lung Cancer

Cost-effectiveness of Nivolumab-Ipilimumab Combination Therapy for the Treatment of Advanced Non–Small Cell Lung Cancer

Cost‐effectiveness analysis of pembrolizumab plus chemotherapy with PD‐L1 test for the first‐line treatment of NSCLC

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