Cost-Effectiveness of Pembrolizumab Versus Carboplatin and Paclitaxel in Patients With Unresectable or Metastatic Melanoma After First-Line Treatment in China

Abstract

This study aimed to evaluate the cost-effectiveness of pembrolizumab compared with standard-of-care chemotherapy (paclitaxel 1 carboplatin [PC]) in patients with unresectable or metastatic melanoma after first-line treatment from a Chinese healthcare system perspective. Methods:We conducted a partitioned-survival model with a 1-week cycle length and a 20-year base-case time horizon. Piecewise parametric models were fitted to KEYNOTE-006 trial data to estimate progression-free survival and overall survival for pembrolizumab, and a network meta-analysis was used to estimate the clinical outcomes for standard of care. Quality-adjusted life-years (QALYs) were calculated using EQ-5D data from KEYNOTE-006, applying Chinese-specific utility tariffs. Costs included drug acquisition, administration, adverse events, and disease management, reflecting the Chinese pricing system. Chinese-specific disease management costs were estimated based on clinical opinion on health state resource use and chemotherapy-related adverse events. Costs and outcomes were discounted at 5% annually. Multiple deterministic and probabilistic sensitivity analyses were performed to test the robustness of the results.Results: In the base-case analysis, the treatment of pembrolizumab is estimated to yield 2.63 life-years (LYs) and 2.24 QALYs at an incremental cost of U372 316.46 versus PC. The incremental costs per LY and per QALY were U141771.00 and U165 865.69, respectively, the latter being below a threshold of 3 times the per capita gross domestic product (￥193 932) in China, deemed as cost-effective according to the World Health Organization threshold. These findings were robust against a wide range of sensitivity analyses.Conclusions: Pembrolizumab is projected as cost-effective compared with PC in patients with unresectable or metastatic melanoma after first-line treatment in China.

Efficacy of Pembrolizumab in Advanced Melanoma: A Narrative Review

“…A recent study based on a partitioned survival model with a 1-week cycle length and a 20-year base-case time horizon evaluated the cost-effectiveness of pembrolizumab versus paclitaxel and carboplatin as a first line in patients with metastatic or unresectable melanoma. Considering that an increase of 2.63 life-years and an increase of 2.24 qualityadjusted life-years was estimated, pembrolizumab emerges as an effective treatment option in metastatic patients as a first line and is also cost-effective, not exceeding the total cost of treatment the three times the per capita gross domestic Chinese [26]. This confirms that first-line therapy with pembrolizumab is not only an effective option but also an economically viable option in countries with a per capita product similar to China.…”