Cost-effectiveness analysis of pembrolizumab versus standard-of-care chemotherapy for first-line treatment of PD-L1 positive (>50%) metastatic squamous and non-squamous non-small cell lung cancer in France

Abstract

In the KEYNOTE-024 trial, pembrolizumab demonstrated significant improvements in progressionfree survival (PFS) and overall survival (OS) versus Standard-of-Care (SoC) platinum-based doublets for first-line treatment of PD-L1-positive (≥50%) metastatic Non-Small-Cell Lung Cancer (NSCLC) patients with no EGFR mutations or ALK translocations. This study aims to assess the cost-effectiveness of pembrolizumab versus SoC platinum-based chemotherapy from the French healthcare system perspective. Methods: A three-state partitioned-survival model was adapted to project outcomes and costs of squamous and non-squamous NSCLC patients respectively, over a 10-year time horizon. Clinical and utility data were collected from the trial. A network meta-analysis was performed to consider platinum-based triplets also used for nonsquamous NSCLC. Direct medical costs were considered based on ressources identified from the trial and literature. Costs and outcomes were discounted at 4% per year. Incremental cost-effectiveness ratios (ICERs) were calculated as cost per Life Year (LY) and cost per Quality-Adjusted Life Year (QALY). Sensitivity and scenario analyses were performed to assess the robustness of results. Results: For squamous NSCLC, pembrolizumab was projected to increase life expectancy of patients by 0.93 LY (11 months), and 0.74 QALY (9 months) for an incremental cost of €62,032 compared with platinum-based doublets. The ICER of pembrolizumab versus platinum-based doublets was €66,825/LY and €84,097/QALY. For non-squamous NSCLC, pembrolizumab was projected to increase life expectancy of patients by 0.85-1.32 LYs (10.2-15.8 months) and 0.64-1.02 QALYs (7.7-12.2 months) for an incremental cost varying from €-14,947-+47,064 depending on the specific comparator. The ICER of pembrolizumab versus platinum-based chemotherapy with paclitaxel plus bevacizumab was €62,846/LY and €78,729/QALY; regimens including pemetrexed were dominated. Results were most sensitive to extrapolations of survival outcomes and assumptions for continued effectiveness and treatment duration of pembrolizumab. Conclusions: Pembrolizumab appears cost-effective versus SoC chemotherapy for first-line treatment of PD-L1positive (50%) metastatic NSCLC patients in France, assuming willingness-to-pay under 100,000€/QALY (OECD threshold in the discussion section). prognosis of lung cancer is generally poor with a 5-year overall survival rate estimated at 10-15% worldwide [2]. In France, 5-year and 10-year survivals rates were 17% and 10% in 2015, respectively [3]. The poor prognosis of lung cancer can be explained by a diagnosis at an advanced stage of the disease. In 2012, about 1.6 million deaths due to lung

First‐line pembrolizumab for non–small cell lung cancer patients with PD‐L1 ≥50% in a multicenter real‐life cohort: The PEMBREIZH study

“…This result may guide the therapeutic decision between a pembrolizumab-chemotherapy combination and monotherapy although the fact remains that there is no data about this comparison. Finally, health-related quality-of-life is improved with pembrolizumab than with chemotherapy 26 and is more cost-effective, 27,28 but there are no health-related QOL data for pembrolizumab-chemotherapy even if the combination would appears to be cost-effective. 29 The results of this retrospective observational study should be considered in the context of the strengths and limitations of the data source and study design.…”

Cost effectiveness of immune checkpoint inhibitors for treatment of non-small cell lung cancer: A systematic review

“…Treatments compared in each study varied across studies. Among studies analyzing the first-line treatment, most studies compared pembrolizumab with platinum-based chemotherapy based on KEYNOTE 024 [9] or KEYNOTE 042 trial [42] (N = 10) [23,25,26,28,32,34,36,38,40,41]. The remainders evaluated pembrolizumab plus chemotherapy versus chemotherapy alone or pembrolizumab alone, combination of atezolizumab and chemotherapy versus chemotherapy.…”

“…In the first-line treatment setting, studies were differentiated according to PD-L1 expression levels (PD-L1 � 50%; PD-L1 � 1%; all PD-L1 expression levels). For patients with PD-L1 � 50%, pembrolizumab could be a cost-effective first-line treatment compared with platinum-based chemotherapy from the perspective of US health care system or third-party payer [23,25], French healthcare system [28] and Hospital Authority in Hong Kong (China) [36], while not cost-effective in the UK [25,26], France [28] or China [34]. Four studies evaluated the cost-effectiveness of first-line treatments in PD-L1 � 1% patients [32,38,40,41].…”

<p>Economic Evaluations of Immune Checkpoint Inhibitors for Patients with Non-Small Cell Lung Cancer: A Systematic Review</p>

“…Four studies were conducted in China, and one of them was conducted in the Hong Kong region. Fourteen, 21,22,[24][25][26][27][28][29][30][31]34,[38][39][40] four, 33,[35][36][37] and three 12,23,32 studies focused on pembrolizumab, nivolumab, and atezolizumab, respectively. No study investigated durvalumab.…”