1. Cost-effectiveness of pembrolizumab as first-line therapy for advanced non-small cell lung cancer.
- Author
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Georgieva M, da Silveira Nogueira Lima JP, Aguiar P Jr, de Lima Lopes G Jr, and Haaland B
- Subjects
- Carcinoma, Non-Small-Cell Lung economics, Carcinoma, Non-Small-Cell Lung mortality, Cost-Benefit Analysis, Evidence-Based Medicine, Humans, Lung Neoplasms economics, Lung Neoplasms mortality, Neoplasm Staging, Programmed Cell Death 1 Receptor antagonists & inhibitors, Quality-Adjusted Life Years, Survival Analysis, United Kingdom, United States, Antibodies, Monoclonal, Humanized therapeutic use, Antineoplastic Agents therapeutic use, Carcinoma, Non-Small-Cell Lung drug therapy, Immunotherapy methods, Lung Neoplasms drug therapy
- 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., (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Published
- 2018
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