Cost effectiveness of pembrolizumab vs chemotherapy as first-line treatment for metastatic NSCLC that expresses high levels of PD-L1 in Switzerland

Bhadhuri, Arjun; Insinga, Ralph P.; Guggisberg, Patrik; Panje, Cédric; Schwenkglenks, Matthias

doi:10.4414/smw.2019.20170

Cited by 18 publications

(32 citation statements)

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“…Assuming it was not possible for patients previously receiving 1L chemotherapy to switch to 2L pembrolizumab after disease progression, the estimated ICER increased to CHF 76,126 per QALY gained, but would still be cost-effective. The findings for the pembrolizumab versus chemotherapy comparison are in line with previous CEA results from the partitioned survival model by Huang et al for the US [ 15 ] and its adaptation for France [ 16 ] and Switzerland [ 17 ]. Further studies which found 1L pembrolizumab is likely to be cost-effective based on different models were made for the US [ 18 ], Singapore [ 19 ] and Hong Kong [ 20 ].…”

Section: Discussionsupporting

confidence: 89%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 89%

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

et al. 2021

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“… 5-year horizon QALY No funding declared. Bhadhuri 2019 [ 20 ] To evaluate the cost-effectiveness of pembrolizumab monotherapy compared with chemotherapy for metastatic NSCLC with PD-L1 tumour progression score (TPS) > = 50%. PD-L1 expression.…”

Section: Resultsmentioning

confidence: 99%

“…The patient population targeted in EEs of biomarker-guided therapies was varied, but fall into two broad categories; patients with a known biomarker status, and patients whose biomarker status is initially unknown. Fourteen studies were performed on a pre-defined group of patients with particular biomarker status [ 20 – 22 , 24 – 30 , 32 , 35 – 37 ]; however, they considered at least one characteristic of companion biomarker tests in their evaluations. Many EEs were conducted using a pre-specified patient group with particular confirmed biomarker status, and authors used this to justify excluding some of the key characteristics of companion biomarker testing from their evaluations.…”

Section: Resultsmentioning

confidence: 99%

“…All included EE studies considered the costs of biomarker testing; however, some details were absent. Some papers did not report the cost of biomarker testing devices [ 19 , 20 , 25 ] and often a lump sum cost was modelled without providing details on how the total cost calculated [ 21 , 22 , 24 , 32 , 36 , 37 ]. Several studies reported at least some details regarding the data source or the names/types of biomarker testing kits [ 6 , 7 , 23 , 26 – 30 , 33 – 35 , 42 ], but many EEs did not consider or report the resource use parameters relevant to the testing of companion biomarkers.…”

Section: Resultsmentioning

confidence: 99%

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How are we evaluating the cost-effectiveness of companion biomarkers for targeted cancer therapies? A systematic review

Seo

Cairns

2021

BMC Cancer

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Background Despite the increasing economic assessment of biomarker-guided therapies, no clear agreement exists whether existing methods are sufficient or whether different methods might produce different cost-effectiveness results. This study aims to examine current practices of modeling companion biomarkers when assessing the cost-effectiveness of targeted cancer therapies. It investigates the current methods in modeling the characteristics of companion diagnostics based on existing economic evaluations of biomarker-guided therapies in cancer. Methods A literature search was performed using Medline, Embase, EconLit, Cochrane library for economic evaluations of biomarker-guided therapies with companion diagnostics in cancer. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Studies were selected using pre-specified eligibility criteria based on the PICO framework. To make the included studies more comparable, we qualitatively synthesized the data under nine domains of methods where consensus was deemed lacking. Results Only four of the twenty-two studies included in this review were found to be of good quality with respect to incorporating the characteristics of companion biomarkers in economic evaluations. However, many evaluations focused on a pre-selected patient group rather than including all patients regardless of their biomarker status. Companion biomarker characteristics captured in evaluations were often limited to the cost or the accuracy of the test. Often, only the costs of biomarker testing were modelled. Clinical outcomes and health state utilities were often not included due to the limited data generated by clinical trials. Methods of economic evaluation were not applied consistently in assessments of companion cancer biomarkers for targeted therapies. It was also shown that conflicting cost-effectiveness results were likely depending on what comparator arm was chosen and what comparison structure was designed in the model. Conclusion We found no consistent approach applied in assessing the value of companion biomarker tests and including the characteristics of biomarkers in an economic evaluation of targeted oncology therapies. Currently, many economic evaluations fail to capture the full value of companion biomarkers beyond sensitivity/specificity and cost related to biomarker testing.

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“…OWSAs performed showed that OS had a major impact on the ICER in four of five studies; in the four cases where PSA was conducted, the Swiss study was likely to be cost-effective; Hong Kong and USA studies were inconclusive, while the USA study was not cost-effective (Appendix p8) [37][38][39][40][41]. Although the OWSA in Canada, China, and USA revealed that several ICER values were most sensitive to OS, PFS and drug costs, this was not true for all studies, with certain ICER values in Australia and France more impacted by high-risk patients, inpatient care or costs alone.…”

mentioning

confidence: 99%

Cost‐effectiveness of precision diagnostic testing for precision medicine approaches against non‐small‐cell lung cancer: A systematic review

Henderson¹,

Keeling²,

French

et al. 2021

Molecular Oncology

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Precision diagnostic testing (PDT) employs appropriate biomarkers to identify cancer patients that may optimally respond to precision medicine (PM) approaches, such as treatments with targeted agents and immuno‐oncology drugs. To date, there are no published systematic appraisals evaluating the cost‐effectiveness of PDT in non‐small‐cell lung cancer (NSCLC). To address this gap, we conducted Preferred Reporting Items for Systematic Reviews and Meta‐Analyses searches for the years 2009–2019. Consolidated Health Economic Evaluation Reporting Standards were employed to screen, assess and extract data. Employing base costs, life years gained or quality‐adjusted life years, as well as willingness‐to‐pay (WTP) threshold for each country, net monetary benefit was calculated to determine cost‐effectiveness of each intervention. Thirty‐seven studies (50%) were included for analysis; a further 37 (50%) were excluded, having failed population‐, intervention‐, comparator‐, outcomes‐ and study‐design criteria. Within the 37 studies included, we defined 64 scenarios. Eleven scenarios compared PDT‐guided PM with non‐guided therapy [epidermal growth factor receptor ( EGFR ), n = 5; programmed death‐ligand 1 (PD‐L1), n = 6]. Twenty‐eight scenarios compared PDT‐guided PM with chemotherapy alone (anaplastic lymphoma kinase, n = 3; EGFR , n = 17; PD‐L1, n = 8). Twenty‐five scenarios compared PDT‐guided PM with chemotherapy alone, while varying the PDT approach. Thirty‐four scenarios (53%) were cost‐effective, 28 (44%) were not cost‐effective, and two were marginal, dependent on their country’s WTP threshold. When PDT‐guided therapy was compared with a therapy‐for‐all patients approach, all scenarios (100%) proved cost‐effective. Seven of 37 studies had been structured appropriately to assess PDT‐PM cost‐effectiveness. Within these seven studies, all evaluated scenarios were cost‐effective. However, 81% of studies had been poorly designed. Our systematic analysis implies that more robust health economic evaluation could help identify additional approaches towards PDT cost‐effectiveness, underpinning value‐based care and enhanced outcomes for patients with NSCLC.

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Cost effectiveness of pembrolizumab vs chemotherapy as first-line treatment for metastatic NSCLC that expresses high levels of PD-L1 in Switzerland

Cited by 18 publications

References 0 publications

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

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

How are we evaluating the cost-effectiveness of companion biomarkers for targeted cancer therapies? A systematic review

Cost‐effectiveness of precision diagnostic testing for precision medicine approaches against non‐small‐cell lung cancer: A systematic review

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