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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.

Author information

1
Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, USA.
2
Medical Oncology Department, A. C. Camargo Cancer Center, Sao Paulo, Brazil.
3
Clinical Oncology Sector, Faculdade de Medicina do ABC, Santo André, Brazil.
4
Sylvester Comprehensive Cancer Center, University of Miami, Miami, USA.
5
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: ben.haaland@hci.utah.edu.

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.

KEYWORDS:

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

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