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Lung Cancer. 2018 Oct;124:248-254. doi: 10.1016/j.lungcan.2018.08.018. Epub 2018 Aug 22.

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

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Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, USA.
Medical Oncology Department, A. C. Camargo Cancer Center, Sao Paulo, Brazil.
Clinical Oncology Sector, Faculdade de Medicina do ABC, Santo André, Brazil.
Sylvester Comprehensive Cancer Center, University of Miami, Miami, USA.
Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, USA; Department of Population Health Sciences and Huntsman Cancer Institute, University of Utah, Salt Lake City, USA. Electronic address:



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.


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).


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.


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.


Bayesian Markov model; Cost-effectiveness; First-line therapy; Immunotherapy; NSCLC; Pembrolizumab

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