Cost-effectiveness of pembrolizumab in combination with chemotherapy in the 1st line treatment of non-squamous NSCLC in the US |
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| Authors: | Ralph P. Insinga David J. Vanness Josephine L. Feliciano Kristel Vandormael Sory Traore Thomas Burke |
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| Affiliation: | 1. Merck Sharp &2. Dohme Corp., Center for Observational and Real-World Evidence, North Wales, PA, USA;3. ralph_insinga@merck.com;5. Department of Health Policy and Administration, Pennsylvania State University, State College, PA, USA;6. The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA;7. Dohme, HTA Statistics Europe, Brussels, Belgium;8. Dohme, HTA Statistics Europe, London, UK;9. Dohme Corp., Center for Observational and Real-World Evidence, Rahway, NJ, USA |
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| Abstract: | ![]()
AbstractAims: To describe cost-effectiveness of pembrolizumab plus platinum and pemetrexed chemotherapy in metastatic, non-squamous, NSCLC patients in the US.Materials and methods: A model is developed utilizing partitioned survival analysis to estimate the cost-effectiveness of KEYNOTE-189 trial comparators pembrolizumab?+?chemotherapy (carboplatin/cisplatin?+?pemetrexed) vs chemotherapy alone. Clinical efficacy, treatment utilization, health utility, and safety data are derived from the trial and projected over 20 years. For extrapolating survival beyond the trial, a novel SEER population-data approach is applied (primary analysis), with separate estimation via traditional parametric extrapolation methods. Costs for drugs and non-drug disease management are also incorporated. Based on an indirect treatment comparison, cost-effectiveness of pembrolizumab?+?chemotherapy vs pembrolizumab monotherapy is evaluated for patients with programmed death-ligand 1 (PD-L1)?≥?50%.Results: In the full non-squamous population, pembrolizumab?+?chemotherapy is projected to increase life expectancy by 2.04 years vs chemotherapy (3.96 vs 1.92), for an approximate doubling of life years. Resultant incremental cost-effectiveness ratios (ICERs) are $104,823/QALY and $87,242/life year. In patients with PD-L1?≥?50% and 1–49%, life expectancy is more than doubled (4.53 vs 1.88 years) and (4.87 vs 2.01 years), with a 32% (2.60 vs 1.97 years) increase in PD-L1?Limitations and conclusions: The addition of pembrolizumab to chemotherapy is projected to extend life expectancy to a point not previously seen in previously untreated metastatic non-squamous NSCLC. Although ICERs vary by sub-group and comparator, results suggest pembrolizumab?+?chemotherapy yields ICERs near, or in most cases, well below a 3-times US per capita GDP threshold of $180,000/QALY, and may be a cost-effective first-line treatment for metastatic non-squamous NSCLC patients. |
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| Keywords: | Lung cancer cost-effectiveness pembrolizumab chemotherapy United States |
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