Cost-Effectiveness of Pembrolizumab Plus Chemotherapy Versus Pembrolizumab Monotherapy in Metastatic Non-Squamous and Squamous NSCLC Patients With PD-L1 Expression ≥ 50%

Frontiers in Pharmacology

Pharmacology

Xiaohui Zeng¹  Liubao Peng²  Xiaomin Wan²  Xia Luo²  Chongqing Tan²  Qiao Liu²  Lidan Yi²  Zhen Zhou³ 

[1] Department of Nuclear Medicine/PET Image Center, The Second Xiangya Hospital of Central South University, Changsha, China;Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, China;Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia;

关键词: NSCLC;    PD-L1;    cost-effectiveness;    pembrolizumab;    squamous;    non-squamous;   

DOI  :  10.3389/fphar.2021.803626

 received in 2021-10-28, accepted in 2021-12-13,  发布年份 2022

来源: Frontiers

【 摘 要 】

Objective To compare the cost-effectiveness of the combination of pembrolizumab and chemotherapy (Pembro+Chemo) versus pembrolizumab monotherapy (Pembro) as the first-line treatment for metastatic non-squamous and squamous non-small-cell lung cancer (NSCLC) with PD-L1expression ≥50%, respectively, from a US health care perspective.Material and Methods A comprehensive Makrov model were designed to compare the health costs and outcomes associated with first-line Pembro+Chemo and first-line Pembro over a 20-years time horizon. Health states consisted of three main states: progression-free survival (PFS), progressive disease (PD) and death, among which the PFS health state was divided into two substates: PFS while receiving first-line therapy and PFS with discontinued first-line therapy. Two scenario analyses were performed to explore satisfactory long-term survival modeling.Results In base case analysis, for non-squamous NSCLC patients, Pembro+Chemo was associated with a significantly longer life expectancy [3.24 vs 2.16 quality-adjusted life-years (QALYs)] and a substantially greater healthcare cost ($341,237 vs $159,055) compared with Pembro, resulting in an ICER of $169,335/QALY; for squamous NSCLC patients, Pembro+Chemo was associated with a slightly extended life expectancy of 0.22 QALYs and a marginal incremental cost of $3,449 compared with Pembro, resulting in an ICER of $15,613/QALY. Our results were particularly sensitive to parameters that determine QALYs. The first scenario analysis yielded lower ICERs than our base case results. The second scenario analysis founded Pembro+Chemo was dominated by Pembro.Conclusion For metastatic non-squamous NSCLC patients with PD-L1 expression ≥50%, first-line Pembro+Chemo was not cost-effective when compared with first-line Pembro. In contrast, for the squamous NSCLC patient population, our results supported the first-line Pembro+Chemo as a cost-effective treatment. Although there are multiple approaches that are used for extrapolating long-term survival, the optimal method has yet to be determined.

【 授权许可】

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Copyright © 2022 Liu, Zhou, Luo, Yi, Peng, Wan, Tan and Zeng.