Cost-effectiveness analysis of pembrolizumab versus chemotherapy as first-line treatment in locally advanced or metastatic non-small cell lung cancer with PD-L1 tumor proportion score 1% or greater.

The purpose of this study was to estimate the cost-effectiveness analysis of pembrolizumab versus chemotherapy as first-line treatment in locally advance or metastatic non-small cell lung cancer (NSCLC) with programmed death ligand 1 (PD-L1) tumor proportion score (TPS) 1% or greater from the United States (US) payer perspective. This Markov structure was developed to estimate cost and effectiveness of pembrolizumab vs chemotherapy in the first-line treatment of locally advance or metastatic NSCLC based on the data from KEYNOTE-042. Cost and health outcomes were estimated at a willingness-to-pay (WTP) threshold of $150,000 per quality adjusted life year (QALY) in three PD-L1 TPS populations (≥50%, ≥20% and ≥1%). One-way, two-way and probabilistic sensitivity analysis were to test the model stability. Subgroup analysis were performed in three PD-L1 TPS populations (≥50%, ≥20% and ≥1%). The incremental costs and QALYs that pembrolizumab yielded, compared with chemotherapy, were $86164.87 and 0.63, $74562.25 and 0.46 and $70886.65 and 0.39 for the populations with a PD-L1 TPS ≥ 50%, TPS ≥ 20% and TPS ≥ 1%, leading an incremental cost-effective ratio (ICER) of $136,228.82, $160,625.98 and $179,530.17 per QALY, respectively. First-line treatment with pembrolizumab is a cost-effective strategy compared with platinum-based chemotherapy when the value of WTP was $150,000 per QALY in locally advanced or metastatic NSCLC patients with PD-L1 TPS ≥ 50% and without epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutations, but not in the TPS ≥ 20% and 1% populations.

She L ，Hu H ，Liao M ，Xia X ，Shi Y ，Yao L ，Ding D ，Zhu Y ，Zeng S ，Shen L ，Huang J ，Carbone DP ... -  《-》

Cost Effectiveness of Pembrolizumab vs. Standard-of-Care Chemotherapy as First-Line Treatment for Metastatic NSCLC that Expresses High Levels of PD-L1 in the United States.

Huang M ，Lou Y ，Pellissier J ，Burke T ，Liu FX ，Xu R ，Velcheti V ... -  《-》

Cost-effectiveness analysis of pembrolizumab monotherapy versus chemotherapy for previously untreated advanced non-small cell lung cancer.

Aziz MIA ，Tan LE ，Tan WHG ，Toh CK ，Loke LPY ，Pearce F ，Ng K ... -  《-》

Cost-effectiveness analysis of pembrolizumab monotherapy and chemotherapy in the non-small-cell lung cancer with different PD-L1 tumor proportion scores.

This study aimed to assess the cost-effectiveness of pembrolizumab monotherapy compared with chemotherapy as first-line treatment in patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) with different tumor proportion scores (TPS), from perspectives of payers in China. Basic information was derived from the KEYNOTE-042 trial. A Markov model was developed to simulate the process of NSCLC. Model inputs were based on published clinical trials and previous literatures. Costs were calculated from perspectives of payers in China. Sensitivity analyses were conducted to explore the impact of uncertainty. Treatment with pembrolizumab monotherapy for patients with high TPS (≥50%) was estimated to increase costs by $65,322 compared with chemotherapy, with a gain of 1.79 quality adjusted life years (QALYs) for an incremental cost-effectiveness ratio (ICER) of $36,493 per QALY. For patient population with TPS ≥ 20%, the ICER was $42,311 per QALY, while the corresponding ICER was $39,404 per QALY for patients with TPS ≥ 1%. Sensitive analyses for three different TPS populations were similar, which indicated the cost of PFS state in pembrolizumab arm and the price of pembrolizumab were the most influential factors in our study. ICERs yield by pembrolizumab monotherapy among different TPS populations were beyond the threshold we set, three times of the Gross Domestic Product per Capita of China in 2018 ($26,508/QALY). It is not a cost effective choice compared with standard chemotherapy for patients with locally advanced or metastatic NSCLC from the perspective of Chinese payer, regardless of TPS. Deeper discount of its current price would make pembrolizumab a preferable choice.

Zhou K ，Jiang C ，Li Q 《-》

Cost effectiveness of pembrolizumab vs chemotherapy as first-line treatment for metastatic NSCLC that expresses high levels of PD-L1 in Switzerland.

Bhadhuri A ，Insinga R ，Guggisberg P ，Panje C ，Schwenkglenks M ... -  《-》