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Cost-Minimization Analysis of Pembrolizumab Monotherapy Versus Nivolumab in Combination with Ipilimumab as First-Line Treatment for Metastatic PD-L1-Positive Non-small Cell Lung Cancer: A US Payer Perspective

Author

Listed:
  • Nan Qiao

    (Merck & Co., Inc.)

  • Ralph Insinga

    (Merck & Co., Inc.)

  • Thomas Burke

    (Merck & Co., Inc.)

  • Gilberto Lopes

    (Sylvester Comprehensive Cancer Center at the University of Miami)

Abstract

Background Pembrolizumab monotherapy and nivolumab in combination with ipilimumab are US FDA-approved first-line (1L) regimens for patients with metastatic non-small cell lung cancer (NSCLC) without epidermal growth factor receptor or anaplastic lymphoma kinase genomic aberrations and with a programmed death ligand 1 (PD-L1) tumor proportion score (TPS) of ≥ 1%. A published matching-adjusted indirect comparison found the two regimens yield comparable overall and progression-free survival outcomes. Objective The aim of this study was to compare direct medical costs of pembrolizumab and nivolumab plus ipilimumab for PD-L1-positive metastatic NSCLC treatment within the first 3 years following treatment initiation from a US payer perspective. Methods A cost-minimization model was built to estimate and compare treatment, disease management, and adverse event costs based on KEYNOTE-024 and -042, and CheckMate 227 Part 1a trial survival and adverse event data. Results 1L pembrolizumab generates $54,343, $75,744, and $76,259 per patient cost savings compared with 1L nivolumab plus ipilimumab for patients with NSCLC with PD-L1 TPS ≥ 1% within 1, 2, and 3 years of treatment initiation, respectively. Conclusion Pembrolizumab is cost saving as 1L treatment for PD-L1-positive metastatic NSCLC in comparison with nivolumab plus ipilimumab, at least for the short term.

Suggested Citation

  • Nan Qiao & Ralph Insinga & Thomas Burke & Gilberto Lopes, 2021. "Cost-Minimization Analysis of Pembrolizumab Monotherapy Versus Nivolumab in Combination with Ipilimumab as First-Line Treatment for Metastatic PD-L1-Positive Non-small Cell Lung Cancer: A US Payer Per," PharmacoEconomics - Open, Springer, vol. 5(4), pages 765-778, December.
    • Handle: RePEc:spr:pharmo:v:5:y:2021:i:4:d:10.1007_s41669-021-00288-1
    DOI: 10.1007/s41669-021-00288-1
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    References listed on IDEAS

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    1. Nan Qiao & Ralph Insinga & Gilberto de Lima Lopes Junior & John Cook & Martin Sénécal, 2021. "A Review of Cost-Effectiveness Studies of Pembrolizumab Regimens for the Treatment of Advanced Non-small Cell Lung Cancer," PharmacoEconomics - Open, Springer, vol. 5(3), pages 365-383, September.
    2. David M. Phillippo & Anthony E. Ades & Sofia Dias & Stephen Palmer & Keith R. Abrams & Nicky J. Welton, 2018. "Methods for Population-Adjusted Indirect Comparisons in Health Technology Appraisal," Medical Decision Making, , vol. 38(2), pages 200-211, February.
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