Cost-effectiveness analysis of pembrolizumab plus chemotherapy for previously untreated metastatic non-small cell lung cancer in the USA. Issue 12 (11th December 2019)

• Record Type: Journal Article
• Authors: Zeng, Xiaohui; Wan, Xiaomin; Peng, Liubao; Peng, Ye; Ma, Fang; Liu, Qiao; Tan, Chongqing
• Is Part Of: BMJ open. Volume 9:Issue 12(2019)
• Publication Date: 2019-12-11
• Subjects: immunology -- chemotherapy -- health economics; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2019-031019
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: Evaluating the cost-effectiveness of pembrolizumab plus standard chemotherapy in the first-line setting for patients with metastatic non-small cell lung cancer (NSCLC) from the US payer perspective. Design: A Markov model was constructed to analyse the cost-effectiveness of pembrolizumab plus chemotherapy in the first-line treatment of metastatic NSCLC. Health outcomes were estimated in quality-adjusted life-years (QALYs). The cost information was from Medicare in 2018. One-way and probabilistic sensitivity analyses examined the impact of uncertainty and assumptions on the results. Setting: The US payer perspective. Participants: A hypothetical US cohort of patients with previously untreated metastatic nonsquamous NSCLC without EGFR or ALK mutations. Interventions: Pembrolizumab plus chemotherapy versus chemotherapy. Primary outcome measures: Costs, QALYs, incremental cost-effectiveness ratio (ICER) of pembrolizumab plus chemotherapy expressed as cost per QALY gained compared with chemotherapy Results: The base case analysis demonstrated that pembrolizumab plus chemotherapy provided an additional 0.78 QALYs at incremental cost of $151 409, resulting in an ICER of $194 372/QALY. ICER for pembrolizumab plus chemotherapy was >$149 680/QALY in all of our univariable and probabilistic sensitivity analyses. Conclusions: Pembrolizumab in addition to chemotherapy provides modest incremental benefit at high incremental cost per QALY for the treatment of previously untreated metastatic NSCLC.