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Cost-effectiveness of pembrolizumab plus chemotherapy versus pembrolizumab monotherapy in metastatic non-squamous and squamous NSCLC patients With PD-L1 expression ≥ 50%

Citation

Liu, Q and Zhou, Z and Luo, X and Yi, L and Peng, L and Wan, X and Tan, C and Zeng, X, Cost-effectiveness of pembrolizumab plus chemotherapy versus pembrolizumab monotherapy in metastatic non-squamous and squamous NSCLC patients With PD-L1 expression ≥ 50%, Frontiers in Pharmacology, 12 Article 803626. ISSN 1663-9812 (2022) [Refereed Article]


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Copyright Statement

Copyright 2022 Liu, Zhou, Luo, Yi, Peng, Wan, Tan and Zeng. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) License (https://creativecommons.org/licenses/by/4.0/). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

DOI: doi:10.3389/fphar.2021.803626

Abstract

Objective To compare the cost-effectiveness of the combination of pembrolizumab and chemotherapy (Pembro+Chemo) versus pembrolizumab monotherapy (Pembro) as the first-line treatment for metastatic non-squamous and squamous non-small-cell lung cancer (NSCLC) with PD-L1expression ≥50%, respectively, from a US health care perspective.

Material and Methods A comprehensive Makrov model were designed to compare the health costs and outcomes associated with first-line Pembro+Chemo and first-line Pembro over a 20-years time horizon. Health states consisted of three main states: progression-free survival (PFS), progressive disease (PD) and death, among which the PFS health state was divided into two substates: PFS while receiving first-line therapy and PFS with discontinued first-line therapy. Two scenario analyses were performed to explore satisfactory long-term survival modeling.

Results In base case analysis, for non-squamous NSCLC patients, Pembro+Chemo was associated with a significantly longer life expectancy [3.24 vs 2.16 quality-adjusted life-years (QALYs)] and a substantially greater healthcare cost ($341,237 vs $159,055) compared with Pembro, resulting in an ICER of $169,335/QALY; for squamous NSCLC patients, Pembro+Chemo was associated with a slightly extended life expectancy of 0.22 QALYs and a marginal incremental cost of $3,449 compared with Pembro, resulting in an ICER of $15,613/QALY. Our results were particularly sensitive to parameters that determine QALYs. The first scenario analysis yielded lower ICERs than our base case results. The second scenario analysis founded Pembro+Chemo was dominated by Pembro.

Conclusion For metastatic non-squamous NSCLC patients with PD-L1 expression ≥50%, first-line Pembro+Chemo was not cost-effective when compared with first-line Pembro. In contrast, for the squamous NSCLC patient population, our results supported the first-line Pembro+Chemo as a cost-effective treatment. Although there are multiple approaches that are used for extrapolating long-term survival, the optimal method has yet to be determined.

Item Details

Item Type:Refereed Article
Keywords:NSCLC, PD-L1, cost-effectiveness, pembrolizumab, squamous, non-squamous
Research Division:Economics
Research Group:Applied economics
Research Field:Health economics
Objective Division:Health
Objective Group:Clinical health
Objective Field:Efficacy of medications
UTAS Author:Zhou, Z (Dr Zhen Zhou)
ID Code:148441
Year Published:2022
Deposited By:Menzies Institute for Medical Research
Deposited On:2022-01-10
Last Modified:2022-02-25
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