Cost-effectiveness analysis of pembrolizumab versus standard of care in recurrent or metastatic squamous cell carcinoma of the head and neck

Abstract

Increasing costs of cancer treatment and anticancer drugs can create a financial burden on society and the individual. Pembrolizumab is an anti-PD-1 inhibitor immunotherapy approved for use in recurrent or metastatic head and neck squamous cell carcinoma. Limited data exists on the cost-effectiveness of pembrolizumab in this setting. This study compares the costeffectiveness of pembrolizumab against traditional chemotherapy using data from KEYNOTE-040. Published data from KEYNOTE-040 were used to create a model estimating treatment costs and overall survival benefit of pembrolizumab and traditional chemotherapy. Costs of treatment of toxicity-related events were obtained from previous literature and were incorporated into the model. Derivation of survival benefit gained from treatment was measured in quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) of pembrolizumab compared to the investigator's choice (IC) was $801,864/QALY. The average drug cost of pembrolizumab would have to approximately decrease by 63% in order to reach the cost-effective threshold of $100,000/ QALY. Pembrolizumab would have to confer a survival benefit of 0.88 QALYs per patient over the IC to reach the cost-effective threshold. Pembrolizumab is not considered cost effective at a threshold of $100,000/QALY based on survival data reported in KEYNOTE-040. Improved long-term outcomes of patients on this relatively new immunotherapy have yet to be reported. Inclusion of these data in the future would likely improve the cost-effectiveness calculations of pembrolizumab and other immunotherapies.

Impact of monoclonal antibody therapy for head and neck cancer on end‐of‐life care utilization and costs

“…Prior studies have demonstrated that median monthly cost of head and neck cancer treatment rose $1000 after the introduction of mAB therapy, and when factoring in the cost of drug-associated adverse events, 24 months of mAB therapy, specifically cetuximab and pembrolizumab, ranged from $13000 to $150000. 19,20 The inherent limitations of this study include its retrospective nature and use of a national database with missing data. We have addressed the missing data through multiple imputation.…”

“…mAB was associated with an additional $10000 of end‐of‐life care costs, which can be attributed to per cycle infusion‐related costs ranging from $2500 to $10000. Prior studies have demonstrated that median monthly cost of head and neck cancer treatment rose $1000 after the introduction of mAB therapy, and when factoring in the cost of drug‐associated adverse events, 24 months of mAB therapy, specifically cetuximab and pembrolizumab, ranged from $13000 to $150000 19,20 …”

Private Payer‐Negotiated Rates for FDA‐Approved Head and Neck Cancer Immunotherapy and Chemotherapy Agents

“…At present, none of the biological medications in our sample meet this threshold for head and neck cancer care. 25,26 Unless negotiated prices of these medications are reduced substantially, or patient selection for therapy is improved (ie, with biomarkers that predict treatment response), these medications may never reach cost-efficacy. In the interim, the ongoing transition toward value-based care models in the United States (ie, bundled payments and accountable care organizations) could potentially reduce the prescription of overly expensive, moderately effective therapies.…”

Nivolumab vs Pembrolizumab for Treatment of US Patients With Platinum-Refractory Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

“…A study by Yeh and Guddati compared the cost-effectiveness of nivolumab vs pembrolizumab in the treatment of R/M HNSCC, yielding the ICERs of nivolumab vs standard of care and pembrolizumab vs standard of care of $484 184 per QALY and $856 173 per QALY, respectively. The differences between the results of their study and ours may be explained as follows.…”

“…Along with this compelling clinical performance, the attendant high price has been in the spotlight. Previous studies have shown that, for US health care payers, both nivolumab and pembrolizumab are cost-effective compared with standard-of-care treatment (methotrexate, docetaxel, or cetuximab), whereas few reports have compared the cost-effectiveness of nivolumab vs pembrolizumab . Thus, this analysis evaluated the cost-effectiveness of nivolumab vs pembrolizumab for the treatment of patients with platinum-refractory R/M HNSCC from the perspective of US health care payers.…”