Cost Effectiveness of Pembrolizumab (Keytruda®) Versus Ipilimumab in Patients with Advanced Melanoma in the United States

Abstract

Objectives: Erlotinib, a representative of targeted therapy, has been approved by FDA for first-line therapy in EGFR-mutations positive NSCLC. However the high price of drug created a large barrier in practice especially in Vietnam. The aim of this study is to estimate the cost-utility of erlotinib versus the standard chemotherapy as firstline therapy in advanced EGFR mutation-positive NSCLC in Vietnam. MethOds: A 3-state Markov model was developed to evaluate the cost-utility of erlotinib versus the standard chemotherapy over life-time horizon. The discount rate of 3% has been evaluated for both cost and QALY. One-way sensitivity analysis was performed to evaluate uncertainties of parameters. Results: Compared with standard therapy, erlotinib regimen in first-line therapy in EGFR-mutations positive NSCLC resulted in the increase of 439.02 million VND treatment cost (534.16 million and 95.14 million VND, respectively) with the increase of 0,11 QALY (1.38 vs 1.27, respectively). The ICUR of erlotinib versus standard chemotherapy was 4.1 billion VND/QALY, which is 34 times higher than the willingness-to-pay of Vietnam (around 120 million VND). One-way sensitivity analysis showed such influencing factors on ICUR as drug price, price of medical services, discount rate, from which price of erlotinib was the most influencing factor. cOnclusiOns: Erlotinib was not cost-effective compared with standard chemotherapy in first-line therapy in EGFR-mutations positive NSCLC.

Legitimacy in bioethics: challenging the orthodoxy

“…For instance, pembrolizumab (Keytruda) has been estimated to improve overall survival in patients with advanced melanoma over ipilimumab (Yervoy) from 58.2% to 74.1%,13 and, in turn, it is estimated to add 1.20 quality-adjusted life-years (QALYs) for a price of $71 417/QALY 14. Using a typical cost-effectiveness threshold of $100 000/QALY added, one might be attracted to pembrolizumab until realising it may cost $1 million for a year of treatment 15.…”