Lenvatinib Plus Pembrolizumab vs. Chemotherapy in Pretreated Patients With Advanced Endometrial Cancer: A Cost-Effectiveness Analysis

Frontiers in Public Health

article

Mingyang Feng¹  Yue Chen¹  Yang Yang¹  Qiu Li¹ 

[1] Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University;West China Biomedical Big Data Center, Sichuan University;National Medical Products Administration Key Laboratory for Clinical Research and Evaluation of Innovative Drugs, Clinical Trial Center, West China Hospital, Sichuan University

关键词: cost-effectiveness;    lenvatinib;    pembrolizumab;    endometrial cancer;    immunotherapy combined therapy;   

DOI  :  10.3389/fpubh.2022.881034

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background In the international, randomized, open-label, phase 3 study 309-KEYNOTE-775 trial, lenvatinib plus pembrolizumab (LP) showed improved progression-free survival (PFS) and overall survival (OS) compared with chemotherapy in pretreated patients with advanced endometrial cancer. This study aimed to investigate whether LP is cost-effective compared with chemotherapy. Materials and Methods The clinical data for this model was derived from the 309-KEYNOTE-775 trial. Costs and utilities were either derived from the standard fee database or extracted from previously published literature. A three-state Markov model was developed to simulate the disease process of patients with advanced endometrial cancer. One-way sensitivity analyses were conducted to investigate the impact of variables in the analysis model. Probabilistic sensitivity analysis was performed based on 10,000 Monte-Carlo simulations. A subgroup analysis was performed to test whether LP is cost-effective in patients with mismatch repair–proficient (pMMR) disease. Results Lenvatinib plus pembrolizumab provided an incremental 0.64 quality-adjusted life years (QALYs) with an incremental cost of $241,278.18, compared with chemotherapy, resulting in the incremental cost-effectiveness ratio (ICER) of $378,251.44/QALY, which exceeded the willingness to pay (WTP) threshold. While in the pMMR subgroup, the ICER increased to $413,256.68/QALY. The variance of the utility of PFS state, the cost of LP, and the utility of the progressive disease state were the most influential factors in the sensitivity analysis. Conclusion Under the current WTP threshold, LP is not cost-effective compared with chemotherapy in pretreated patients with advanced endometrial cancer.

【 授权许可】

CC BY