A cost-effectiveness analysis of pembrolizumab with or without chemotherapy for the treatment of patients with metastatic, non-squamous non-small cell lung cancer and high PD-L1 expression in Switzerland

Abstract

Introduction Pembrolizumab monotherapy or in combination with chemotherapy are two new treatment options for patients with metastatic non-squamous non-small cell lung cancer (NSCLC) and high (≥ 50%) programmed death ligand 1 (PD-L1) expression. We conducted a cost-effectiveness analysis for Switzerland comparing these two options but also pembrolizumab to chemotherapy. Methods We constructed a 3-state Markov model with a time horizon of 10 years. Parametric functions were fitted to Kaplan–Meier overall survival (OS) and progression-free survival (PFS) using 2-year follow-up data from the KN-024 and KN-189 registration trials. We included estimated costs for further treatment lines and costs for best supportive care. Costs were assessed from the Swiss healthcare payer perspective. We used published utility values. Results Combination therapy resulted in an expected gain of 0.17 quality-adjusted life years (QALYs) per patient and incremental costs of Swiss Francs (CHF) 81,085 as compared to pembrolizumab. These estimates led to an incremental cost-effectiveness ratio (ICER) of CHF 475,299/QALY. Pembrolizumab in comparison to chemotherapy was estimated to generate mean incremental QALYs of 0.83 and incremental costs of CHF 56,585, resulting in an ICER of CHF 68,580/QALY. Results were most sensitive to changes in costs of 1L pembrolizumab and combination therapy, together with changes in PFS. In the probabilistic sensitivity analysis, we estimated combination therapy was cost-effective in 4.9% of the simulations and pembrolizumab monotherapy in 82.9%, assuming a willingness-to-pay threshold of CHF 100,000 per QALY gained. Conclusions Pembrolizumab is likely to be cost-effective from the Swiss healthcare payer perspective, whereas pembrolizumab plus chemotherapy is not.

Cost-Effectiveness of Pembrolizumab for the treatment of Non–Small-Cell lung cancer: A systematic review

“…The results of the cost-effectiveness analysis suggested that pembrolizumab monotherapy was more likely to be cost-effective in Switzerland, the United States, France, and Hong Kong, whereas the studies conducted in the background of the United Kingdom, mainland China, and Singapore indicated the contrary. Among these, two studies ( 23 , 24 ) from the perspective of Swiss payers reached ICERs of CHF 68,580 (USD 73,813)/QALY and CHF 57,402 (USD 61,782)/QALY respectively, both below the same WTP. The UK perspective of the study by Georgieva et al.…”

Comparison of time to failure of pembrolizumab plus chemotherapy versus pembrolizumab monotherapy: a consecutive analysis of patients having NSCLC with high PD-L1 expression

“…Immunotherapy is an expensive treatment, and its economic impacts need to be considered. In the USA, both monotherapy and combination therapy were suggested to be more cost-effective than chemotherapy [ 18 , 19 ]; however, Barbier et al suggested that the cost-effectiveness of combination therapy is marginal compared to monotherapy in Switzerland [ 20 ]. Moreover, combination therapy is more toxic than monotherapy.…”

Cost-effectiveness and budget impact of venetoclax in combination with rituximab in relapsed/refractory chronic lymphocytic leukemia in Switzerland

“…outlined in Glick et al [ 26 ]}. The resulting ICERs were compared with a willingness-to-pay (WTP) threshold of Swiss Francs (CHF) 100,000/QALY, which is sometimes tentatively considered in analyses for Switzerland [ 27 – 29 ]. In an additional analysis, we defined an “average comparator” as a weighted average of the mean costs and QALYs of all six comparators considered in the analysis.…”

“…outlined in Glick et al [26]}. The resulting ICERs were compared with a willingness-to-pay (WTP) threshold of Swiss Francs (CHF) 100,000/QALY, which is sometimes tentatively considered in analyses for Switzerland [27][28][29].…”