Cost‐Utility Analysis of Pembrolizumab Versus Chemotherapy as First-Line Treatment for Metastatic Non-Small Cell Lung Cancer With Different PD-L1 Expression Levels

Abstract

To evaluate the cost‐utility of pembrolizumab versus chemotherapy as the first-line setting for metastatic non-small cell lung cancer (NSCLC) from the US health care system perspective, a Markov model was developed to compare the lifetime cost and effectiveness of pembrolizumab versus chemotherapy for untreated metastatic NSCLC, based on the clinical data derived from phase III randomized controlled trial (KEYNOTE-042; ClinicalTrials.gov; NCT02220894). Weibull distribution was fitted to simulate the parametric survival functions. Drug costs were collected from official websites, and utility values were obtained from published literature. Total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were computed as primary output indicators. The impact of different PD-L1 expression levels on ICER was also evaluated. One-way and probabilistic sensitivity analyses were performed to assess the model uncertainty. Compared with chemotherapy, patients treated with pembrolizumab provided an additional 1.13, 1.01, and 0.59 QALYs in patients with PD-L1 expression levels of ≥50%, ≥20%, and ≥1%, with corresponding incremental cost of 53,784, 47,479, and 39,827, respectively. The resultant ICERs of pembrolizumab versus chemotherapy were 47,596, 47,184, and 68,061/QALY, in three expression levels of PD-L1, respectively, all of which did not exceed the WTP threshold of 180,000/QALY. Probability sensitivity analysis outcome supported that pembrolizumab exhibited evident advantage over chemotherapy to be cost-effective. One-way sensitivity analysis found that ICERs were most sensitive to utility value of pembrolizumab in progression survival state. All the adjustment of parameters did not qualitatively change the result. For treatment-naive, metastatic NSCLC patients with PD-L1+, pembrolizumab was estimated to be cost-effective compared with chemotherapy for all PD-L1 expression levels at a WTP threshold of 180,000/QALY in the context of the US health care system.

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]. Most studies were assessed from the perspective of health care system (N = 12) [20-22, 25, 26, 28-31, 35, 37, 40], some used a payer perspective (N = 8) [23,24,27,32,33,38,39,41], and the remainder used a perspective of society (N = 1) [34] and hospital authority (N = 1) [36].…”

“…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.…”

<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.…”