Cost Effectiveness of Pembrolizumab vs. Standard-of-Care Chemotherapy as First-Line Treatment for Metastatic NSCLC that Expresses High Levels of PD-L1 in the United States

Huang, Min; Lou, Yanyan; Pellissier, James M.; Burke, Thomas; Liu, Frank Xiaoqing; Xu, Ruifeng; Velcheti, Vamsidhar

doi:10.1007/s40273-017-0527-z

Cited by 112 publications

(134 citation statements)

References 27 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background The KEYNOTE‐024 trial demonstrated that pembrolizumab, a PD‐1 inhibitor, significantly improves progression‐free survival (PFS) and overall survival (OS) in selected patients with previously untreated advanced non–small cell lung cancer (NSCLC) with a PD‐L1 tumor proportion score (TPS) ≥50% and without EGFR/ALK aberrations. The main aim of this study was to report the efficacy and safety profile of pembrolizumab in real‐life conditions. Method This was a French retrospective multicenter longitudinal study of 108 consecutive patients with advanced NSCLC, a PD‐L1 TPS ≥50% and without EGFR/ALK aberrations who were treated by pembrolizumab, in first line. Patient data were obtained from medical files. Results The main characteristics of the cohort were: median age [range] 66.7 [37‐87] years, 64.8% male, 23.1% with a performance status (PS) of 2, and 88.9% current or former smokers. Eighty‐seven percent had stage IV NSCLC at diagnosis, 9.2% untreated brain metastases at inclusion,. With a median follow‐up of 8.2 months, the median PFS was 10.1 months (95% CI, 8.8‐11.4). The objective response rate was 57.3% (complete response 2.7%, partial response 54.6%). Disease control rate was 71.1%. At 6 months, the OS rate estimated was 86.2%. Treatment‐related adverse events (AE) of grade 3 occurred in 8% of patients. There were no grade 4 or 5 AEs. Conclusion In a real‐life cohort of advanced NSCLC patients (including PS 2 and untreated brain metastases), with PD‐L1 TPS ≥50%, pembrolizumab demonstrates similar PFS to the pivotal clinical trial.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…The Second Panel on Cost-Effectiveness in Health and Medicine recommended the inclusion of both the societal perspective and health system perspective for the sake of consistency and comparability of cost-effectiveness analyses 29 ; however, because of the lack of consistency in the conceptualization and interpretation of the societal perspective, to our knowledge it is unclear whether the comparability of cost-effectiveness analyses estimates will be improved by promoting a societal perspective. 18,32 A study by Insinga et al conducted in the United States demonstrated that pembrolizumab plus chemotherapy was cost-effective, with an ICER of $104,823 per QALY compared with chemotherapy. The majority of US-based cost-effectiveness analyses aim to support the payer's decision making regarding the coverage and reimbursement of health care.…”

Section: Discussionmentioning

confidence: 99%

“…Two US-based studies demonstrated that pembrolizumab monotherapy was cost-effective compared with platinum-based chemotherapy. 18,32 A study by Insinga et al conducted in the United States demonstrated that pembrolizumab plus chemotherapy was cost-effective, with an ICER of $104,823 per QALY compared with chemotherapy. 33 The authors found that the addition of pembrolizumab to chemotherapy extended life expectancy by 2.04 years compared with chemotherapy (3.96 years vs 1.92 years), which to our knowledge has not been observed previously among treatment-naive patients with metastatic, nonsquamous NSCLC.…”

Section: Discussionmentioning

confidence: 99%

First‐line atezolizumab in addition to bevacizumab plus chemotherapy for metastatic, nonsquamous non–small cell lung cancer: A United States–based cost‐effectiveness analysis

Wan

Luo

Tan

et al. 2019

Cancer

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BACKGROUND:The IMpower150 trial found that adding atezolizumab to the combination of bevacizumab and chemotherapy improved survival for patients with metastatic, nonsquamous non-small cell lung cancer (NSCLC). However, considering the high cost of immunotherapy, there is a need to assess its value by considering both efficacy and cost. The current study evaluated the cost-effectiveness of atezolizumab in the first-line setting for the treatment of patients with metastatic NSCLC from the US payer perspective. METHODS: A Markov model was developed to compare the lifetime cost and effectiveness of the combination of atezolizumab, bevacizumab, carboplatin, and paclitaxel (ABCP) with the combination of bevacizumab, carboplatin, and paclitaxel (BCP) and carboplatin and paclitaxel (CP) in the first-line treatment of patients with metastatic NSCLC. Life-years (LYs), qualityadjusted LYs (QALYs), and lifetime costs were estimated. One-way and probabilistic sensitivity analyses were performed to evaluate the model uncertainty. Additional subgroup analyses were performed. RESULTS: ABCP provided an additional 0.413 QALYs (0.460 LYs) and 0.738 QALYs (0.956 LYs), respectively, compared with BCP and CP. The corresponding incremental costs were $234,998 and $381,116, respectively. The incremental cost-effectiveness ratio for ABCP was $568,967 per QALY compared with BCP and $516,114 per QALY compared with CP. The subgroup analysis demonstrated that PD-L1 expression of ≥50% on tumor cells (TC3) or ≥10% on immune cells (IC3) decreased the incremental cost-effectiveness ratio to $464,703 per QALY. CONCLUSIONS: From the perspective of the US payer, ABCP is estimated to not be cost-effective compared with BCP or CP in the first-line setting for patients with metastatic, nonsquamous NSCLC at a willingness-to-pay threshold of $100,000 per QALY. Cancer 2019;125:3526-3534.

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“…For patients with PD and receiving salvage chemotherapy and supportive care, the estimated cost was derived from a published study . An end‐of‐life care cost of $32,841 was applied to each death . The costs of T790 M mutation screening ($966) and tissue biopsy ($3,548) were included in the second‐line osimertinib strategy .…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness of Osimertinib in Treating Newly Diagnosed, Advanced EGFR-Mutation-Positive Non-Small Cell Lung Cancer

Wu¹,

Zhang

et al. 2018

The Oncologist

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Background The objective of this study was to assess cost and effectiveness of osimertinib in treating newly diagnosed advanced non‐small cell lung cancer with an epidermal growth factor receptor (EGFR) mutation from a public payer's perspective in the U.S. and China. Materials and Methods Markov models were developed to compare three treatment strategies: first‐line use of osimertinib, first‐line use of the standard first‐generation EGFR‐tyrosine kinase inhibitor (EGFR‐TKI) followed by the second‐line use of osimertinib, and the standard first‐generation EGFR‐TKI therapy (standard care [SOC]). Clinical data, cost, and utility data were mainly derived from published literatures. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the incremental cost per quality‐adjusted life year (QALY) between the treatments. Results The resultant incremental cost per QALY gained for the first‐line osimertinib versus SOC was $312,903 in the U.S. and $41,512 in China. The incremental cost per QALY for the second‐line osimertinib versus SOC was $284,532 in the U.S. and $38,860 in China. The probability of the SOC strategy being cost‐effective is 1.0 if the willingness to pay threshold is below $150,000/QALY in the U.S. and below $30,000/QALY in China. Conclusion Osimertinib as first‐line treatment could gain more health benefits in comparison with standard EGFR‐TKIs or second‐line use of osimertinib. However, because of the high cost of treatment, the cost‐effectiveness analyses were not in favor of the first‐line use of osimertinib from a public payer's perspective in the U.S. and China. Implications for Practice Osimertinib as first‐line treatment yielded the greatest health outcomes but is not a cost‐effective strategy for lung cancer in the U.S. and China. The price of osimertinib has a substantial impact on economic outcomes.

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Cost Effectiveness of Pembrolizumab vs. Standard-of-Care Chemotherapy as First-Line Treatment for Metastatic NSCLC that Expresses High Levels of PD-L1 in the United States

Cited by 112 publications

References 27 publications

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

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

First‐line atezolizumab in addition to bevacizumab plus chemotherapy for metastatic, nonsquamous non–small cell lung cancer: A United States–based cost‐effectiveness analysis

Cost-Effectiveness of Osimertinib in Treating Newly Diagnosed, Advanced EGFR-Mutation-Positive Non-Small Cell Lung Cancer

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