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Cost-effectiveness analysis of pembrolizumab plus standard chemotherapy versus chemotherapy alone for first-line treatment of metastatic non-squamous non–small-cell lung cancer in China
  1. Yuan Jiang1,
  2. Xingwei Wang2
  1. 1Department of Pharmacy, Tianjin Union Medical Center, Tianjin, China
  2. 2Center for Combinatorics, Nankai University, Tianjin, China
  1. Correspondence to Mrs Yuan Jiang; jy_0609{at}163.com

Abstract

Objective To determine whether the first-line treatment using pembrolizumab plus standard chemotherapy of platinum and pemetrexed for patients with metastatic, non-squamous, non–small-cell lung cancer (NSCLC) is cost-effective in China.

Methods We applied partitional survival analysis to assess the cost-effectiveness of pembrolizumab plus the cytotoxic chemotherapy (cisplatin/carboplatin and pemetrexed) in metastatic NSCLC in China. We took into account direct medical costs according to the data derived from the KEYNOTE-189 trial and literature. Incremental cost-effectiveness ratio (ICER) was assessed as per life-year (LY) and per quality-adjusted life-year (QALY), with 3% per year discounted rate of costs and outcomes. In the performance of sensitivity analysis, cost of disease-management, utility-PFS (progression-free survival), utility-PD (progressive disease) and the discount were considered as variables. In scenario analysis, a philanthropic support programme in China was considered. The threshold was set to be $28 106/QALY (corresponding to three times the GDP in China).

Results Treatment with pembrolizumab plus platinum and pemetrexed chemotherapy was estimated to increase cost by $139 168 compared with $73 081 (the cost of treatment with chemotherapy alone), leading to ICER of $80 444/LY and $96 644/QALY. Incremental costs/QALY are $90 419, $91 399 and $109 229 for programmed death ligand-1 TPS (tumour proportion scores) ≥50%, 1%–49% and <1% subgroups, respectively. Sensitivity analysis revealed that the price of pembrolizumab and the cost of disease-management in progressive-disease state were major variables.

Conclusion In patients with metastatic non-squamous NSCLC, pembrolizumab plus standard chemotherapy of platinum and pemetrexed as the first-line treatment is not cost-effective in China, regardless of TPS.

  • pharmacoeconomics
  • clinical pharmacy
  • cost-price calculation
  • health economics
  • respiratory tract tumours
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