Cost–effectiveness of pembrolizumab versus chemotherapy as first-line treatment in PD-L1-positive advanced non-small-cell lung cancer in the USA

Abstract

Aim: This analysis aimed to evaluate the cost–effectiveness of pembrolizumab monotherapy as first-line treatment in advanced non-small-cell lung cancer patients with a programmed death ligand 1 (PD-L1) tumor proportion score ≥1% from a US payer perspective. Materials & methods: A partitioned survival model was developed using efficacy and safety data from the KEYNOTE-042 trial and projected over 20 years. Costs accounted for treatment, toxicity and disease management. Quality-adjusted life-years (QALYs) and incremental cost–effectiveness ratios were reported. Results: Pembrolizumab resulted in an expected gain of 0.60 life years and 0.49 QALYs compared with platinum-based chemotherapy. The incremental cost–effectiveness ratio was US$130,155/QALY. Conclusion: Pembrolizumab is projected to be cost-effective compared with platinum-based chemotherapy as first-line treatment for advanced non-small-cell lung cancer with PD-L1 tumor proportion score ≥1%.

<p>Economic Evaluations of Immune Checkpoint Inhibitors for Patients with Non-Small Cell Lung Cancer: A Systematic Review</p>

“…Four studies were conducted in China, and one of them was conducted in the Hong Kong region. Fourteen, 21,22,[24][25][26][27][28][29][30][31]34,[38][39][40] four, 33,[35][36][37] and three 12,23,32 studies focused on pembrolizumab, nivolumab, and atezolizumab, respectively. No study investigated durvalumab.…”

“…The expression of PD-L1 affects the selection of immune checkpoint inhibitors. Fourteen studies 21,22,[24][25][26][27][28][29][30][31]34,[38][39][40] mentioned positive PD-L1 or high level of PD-L1, whereas one studies 36 explored the cost-effectiveness of PD-L1 testing. The other studies were not clearly stated.…”

“…About half of the studies 12,[22][23][24][25][28][29][30][31]33,36,38,39 did not provide reasons for their selected decision-analytic model nor report heterogeneity. Most studies 12,[21][22][23][24][25][26][27][28][31][32][33][34]37,39,40 did not mention whether there was preference measurement and evaluation. Many studies 12,22,23,25,26,28,30,31,34,35,37,38,40 did not report currency, price date and conversion.…”

Cost effectiveness of immune checkpoint inhibitors for treatment of non-small cell lung cancer: A systematic review

“…The characteristics of all included studies are presented in S1 Table. Most of the studies were conducted in 2019 [28][29][30][31][32][33][34][35][36][37][38][39][40][41]. Studies were conducted from countries all over the world, with ten from the USA [22-27, 29, 30, 32, 33], seven from China (one from HongKong) [34][35][36][38][39][40][41], two from Canada [20,37], and one each from Australia [31], France [28] and Switzerland [21].…”

“…Treatments compared in each study varied across studies. Among studies analyzing the first-line treatment, most studies compared pembrolizumab with platinum-based chemotherapy based on KEYNOTE 024 [9] or KEYNOTE 042 trial [42] (N = 10) [23,25,26,28,32,34,36,38,40,41]. The remainders evaluated pembrolizumab plus chemotherapy versus chemotherapy alone or pembrolizumab alone, combination of atezolizumab and chemotherapy versus chemotherapy.…”