Cost-effectiveness of pembrolizumab as first-line therapy for advanced non-small cell lung cancer. (October 2018)

• Record Type: Journal Article
• Authors: Georgieva, Mina; da Silveira Nogueira Lima, Joao P.; Aguiar, Pedro; de Lima Lopes, Gilberto; Haaland, Benjamin
• Is Part Of: Lung cancer. Volume 124(2018)
• Page Start: 248
• Page End: 254
• Publication Date: 2018-10
• Subjects: Bayesian Markov model -- Cost-effectiveness -- First-line therapy -- Immunotherapy -- NSCLC -- Pembrolizumab; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2018.08.018
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: We assessed cost-effectiveness of first-line pembrolizumab for advanced NSCLC. ICERs varied from $31k to $52k per EoL adjusted QALY in the UK and US. Evidence suggests pembrolizumab may be high value in the US but not the UK. Abstract: Background: Anti-PD-1 immunotherapy has dramatically shifted therapeutic perspectives for advanced non-small cell lung cancer (NSCLC). We assessed cost-effectiveness of anti-PD-1 antibody pembrolizumab compared to platinum-doublet chemotherapy as first-line therapy for advanced NSCLC. Methods: We retrieved survival, progression, and safety data comparing first-line pembrolizumab to platinum-doublets for advanced NSCLC patients with PD-L1 expression ≥50%, non-mutated EGFR, and non-translocated ALK, from KEYNOTE-024. Published United Kingdom (UK) and United States (US) costs informed incremental cost-effectiveness ratios (ICERs). Our analysis was based on a Bayesian Markov model of disease with full lifetime horizon. We estimated costs in USD and summarized effectiveness as quality-adjusted life-years (QALYs). Results: Patients treated with pembrolizumab accumulated 1.80 QALYs (95% CrI 1.56–1.89), for moderate dependency between outcomes, compared to 1.06 QALYs (0.94–1.13) with chemotherapy. From a British National Health System (NHS) perspective, the ICER was $52k ($43k–$69k) per end-of-life (EoL) adjusted QALY gained, above the 42k USD threshold, while from a US cost perspective, the ICER was $49k ($40k-67k) per EoL adjusted QALY, below the hypothetical 100k USD threshold. Conclusions: Evidence suggests first-line pembrolizumab for NSCLC may be cost-effective in the US but not the UK, in spite of very similar ICER values in both countries.