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A cost-effectiveness analysis of pembrolizumab with or without chemotherapy for the treatment of patients with metastatic, non-squamous non-small cell lung cancer and high PD-L1 expression in Switzerland

Author

Listed:
  • Michaela Carla Barbier

    (University of Basel)

  • Esther Pardo

    (Cantonal Hospital Lucerne)

  • Cédric Michael Panje

    (Cantonal Hospital St. Gallen)

  • Oliver Gautschi

    (Cantonal Hospital Lucerne
    University of Bern)

  • Judith Eva Lupatsch

    (University of Basel)

Abstract

Introduction Pembrolizumab monotherapy or in combination with chemotherapy are two new treatment options for patients with metastatic non-squamous non-small cell lung cancer (NSCLC) and high (≥ 50%) programmed death ligand 1 (PD-L1) expression. We conducted a cost-effectiveness analysis for Switzerland comparing these two options but also pembrolizumab to chemotherapy. Methods We constructed a 3-state Markov model with a time horizon of 10 years. Parametric functions were fitted to Kaplan–Meier overall survival (OS) and progression-free survival (PFS) using 2-year follow-up data from the KN-024 and KN-189 registration trials. We included estimated costs for further treatment lines and costs for best supportive care. Costs were assessed from the Swiss healthcare payer perspective. We used published utility values. Results Combination therapy resulted in an expected gain of 0.17 quality-adjusted life years (QALYs) per patient and incremental costs of Swiss Francs (CHF) 81,085 as compared to pembrolizumab. These estimates led to an incremental cost-effectiveness ratio (ICER) of CHF 475,299/QALY. Pembrolizumab in comparison to chemotherapy was estimated to generate mean incremental QALYs of 0.83 and incremental costs of CHF 56,585, resulting in an ICER of CHF 68,580/QALY. Results were most sensitive to changes in costs of 1L pembrolizumab and combination therapy, together with changes in PFS. In the probabilistic sensitivity analysis, we estimated combination therapy was cost-effective in 4.9% of the simulations and pembrolizumab monotherapy in 82.9%, assuming a willingness-to-pay threshold of CHF 100,000 per QALY gained. Conclusions Pembrolizumab is likely to be cost-effective from the Swiss healthcare payer perspective, whereas pembrolizumab plus chemotherapy is not.

Suggested Citation

  • Michaela Carla Barbier & Esther Pardo & Cédric Michael Panje & Oliver Gautschi & Judith Eva Lupatsch, 2021. "A cost-effectiveness analysis of pembrolizumab with or without chemotherapy for the treatment of patients with metastatic, non-squamous non-small cell lung cancer and high PD-L1 expression in Switzerl," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(5), pages 669-677, July.
  • Handle: RePEc:spr:eujhec:v:22:y:2021:i:5:d:10.1007_s10198-021-01282-4
    DOI: 10.1007/s10198-021-01282-4
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    References listed on IDEAS

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    1. Christos Chouaid & Lionel Bensimon & Emilie Clay & Aurélie Millier & Laurie Levy-Bachelot & Min Huang & Pierre Lévy, 2019. "Cost-effectiveness analysis of pembrolizumab versus standard-of-care chemotherapy for first-line treatment of PD-L1 positive (>50%) metastatic squamous and non-squamous non-small cell lung cancer in F," Post-Print hal-02273984, HAL.
    2. Min Huang & Yanyan Lou & James Pellissier & Thomas Burke & Frank Xiaoqing Liu & Ruifeng Xu & Vamsidhar Velcheti, 2017. "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," PharmacoEconomics, Springer, vol. 35(8), pages 831-844, August.
    3. Herbert H. Loong & Carlos K. H. Wong & Linda Kam Suet Leung & Praveen Dhankhar & Ralph P. Insinga & Sheenu Chandwani & Danny C. Hsu & Mary Y. K. Lee & Min Huang & James Pellissier & Akanksha Rai & Mon, 2020. "Cost Effectiveness of PD-L1-Based Test-and-Treat Strategy with Pembrolizumab as the First-Line Treatment for Metastatic NSCLC in Hong Kong," PharmacoEconomics - Open, Springer, vol. 4(2), pages 235-247, June.
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    Cited by:

    1. Michaela Barbier & Nicholas Durno & Craig Bennison & Mathias Örtli & Christian Knapp & Matthias Schwenkglenks, 2022. "Cost-effectiveness and budget impact of venetoclax in combination with rituximab in relapsed/refractory chronic lymphocytic leukemia in Switzerland," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(5), pages 837-846, July.

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    More about this item

    Keywords

    Non-small cell lung cancer; Pembrolizumab; Cost-effectiveness; Markov model;
    All these keywords.

    JEL classification:

    • I19 - Health, Education, and Welfare - - Health - - - Other

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