Journal Article

Cost Effectiveness of Pembrolizumab vs. Standard-of-Care Chemotherapy as First-Line Treatment for Metastatic NSCLC that Expresses High Levels of PD-L1 in the United States

Pellissier, James, Burke, Thomas, Velcheti, Vamsidhar, Liu, Frank Xiaoqing, Xu, Ruifeng, Huang, Min, Lou, Yanyan

2017

Overview

Objectives Our objectives were to evaluate the cost effectiveness of pembrolizumab compared with standard-of-care (SoC) platinum-based chemotherapy as first-line treatment in patients with metastatic non-small-cell lung cancer (NSCLC) that expresses high levels of programmed death ligand-1 (PD-L1) [tumour proportion score (TPS) ≥50%], from a US third-party public healthcare payer perspective. Methods We conducted a partitioned-survival model with a cycle length of 1 week and a base-case time horizon of 20 years. Parametric models were fitted to Kaplan–Meier estimates of time on treatment, progression-free survival and overall survival from the KEYNOTE-024 randomized clinical trial (patients aged ≥18 years with stage IV NSCLC, TPS ≥50%, without epidermal growth factor receptor ( EGFR )-activating mutations or anaplastic lymphoma kinase ( ALK ) translocations who received no prior systemic chemotherapy) and validated with long-term registry data. Quality-adjusted life-years (QALYs) were calculated based on EuroQoL-5 Dimensions (EQ-5D) utility data collected in the trial. Costs ($US, year 2016 values) for drug acquisition/administration, adverse events and clinical management were included. Costs and outcomes were discounted at 3% per year. A series of deterministic and probabilistic sensitivity analyses were performed to test the robustness of the results. Results In the base-case scenario, pembrolizumab resulted in an expected gain of 1.31 life-years (LYs) and 1.05 QALYs and an incremental cost of $US102,439 compared with SoC. The incremental cost per QALY gain was $US97,621/QALY and the incremental cost per LY gain was $US78,344/LY. Conclusions Pembrolizumab is projected to be a cost-effective option compared with SoC platinum-based chemotherapy as first-line treatment in adults with metastatic NSCLC expressing high levels of PD-L1.

• Publisher: Springer International Publishing,Springer,Springer Nature B.V
• Subject: Antibodies, Monoclonal, Humanized - economics / Antibodies, Monoclonal, Humanized - therapeutic use / Antineoplastic Agents, Immunological - economics / Antineoplastic Agents, Immunological - therapeutic use / B7-H1 Antigen - genetics / Cancer / Carcinoma, Non-Small-Cell Lung - drug therapy / Carcinoma, Non-Small-Cell Lung - economics / Carcinoma, Non-Small-Cell Lung - pathology / Care and treatment / Chemotherapy / Comparative analysis / Cost analysis / Cost benefit analysis / Costs / Disease-Free Survival / Economic aspects / Epidermal growth factor / FDA approval / Health Administration / Health Economics / Humans / Immunotherapy / Kaplan-Meier Estimate / Ligands / Lung cancer / Lung cancer, Non-small cell / Lung Neoplasms - drug therapy / Lung Neoplasms - economics / Lung Neoplasms - pathology / Lymphoma / Medical care, Cost of / Medical prognosis / Medicare / Medicine / Medicine & Public Health / Metastasis / Methods / Middle Aged / Models, Statistical / Monoclonal antibodies / Mutation / Neoplasm Metastasis / Neoplasm Staging / Oncology / Original / Original Research Article / Patients / Pharmacoeconomics and Health Outcomes / Platinum / Public Health / Quality of Life / Quality of Life Research / Quality-Adjusted Life Years / Randomized Controlled Trials as Topic / Sensitivity analysis / Standard of care / Survival / Targeted cancer therapy / Third party / Toxicity / Tumors