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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

Author

Listed:
  • Min Huang

    (Merck & Co., Inc.)

  • Yanyan Lou

    (Mayo Clinic)

  • James Pellissier

    (Merck & Co., Inc.)

  • Thomas Burke

    (Merck & Co., Inc.)

  • Frank Xiaoqing Liu

    (Merck & Co., Inc.)

  • Ruifeng Xu

    (Merck & Co., Inc.)

  • Vamsidhar Velcheti

    (Cleveland Clinic)

Abstract

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.

Suggested Citation

  • 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.
  • Handle: RePEc:spr:pharme:v:35:y:2017:i:8:d:10.1007_s40273-017-0527-z
    DOI: 10.1007/s40273-017-0527-z
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    Cited by:

    1. 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.
    2. Steven D Criss & Lauren Palazzo & Tina R Watson & Adelle M Paquette & Keith Sigel & Juan Wisnivesky & Chung Yin Kong, 2020. "Cost-effectiveness of pembrolizumab for advanced non-small cell lung cancer patients with varying comorbidity burden," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-15, January.
    3. Haiying Ding & Wenxiu Xin & Yinghui Tong & Jiao Sun & Gaoqi Xu & Ziqi Ye & Yuefeng Rao, 2020. "Cost effectiveness of immune checkpoint inhibitors for treatment of non-small cell lung cancer: A systematic review," PLOS ONE, Public Library of Science, vol. 15(9), pages 1-16, September.

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