Cost-effectiveness of neoadjuvant pembrolizumab plus chemotherapy with adjuvant pembrolizumab for early-stage non-small cell lung cancer in the United States

Frontiers in Immunology

Immunology

Wentao Tian¹  Gang Xiao¹  Fuxing Deng¹  Guilong Tanzhu¹  Ziqi Wang¹  Lishui Niu¹  Ruoyu Lu¹  Rongrong Zhou² 

[1] Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China;Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China;Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha, China;National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China;

关键词: neoadjuvant;    adjuvant;    pembrolizumab;    cost-effectiveness;    early-stage;    non-small cell lung cancer;   

DOI  :  10.3389/fimmu.2023.1268070

 received in 2023-07-27, accepted in 2023-09-11,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionPerioperative (neoadjuvant and adjuvant) pembrolizumab has shown favorable efficacy in patients with early-stage non-small cell lung cancer (NSCLC). This study aims to evaluate the cost-effectiveness of this treatment from the perspective of the United States healthcare payers.MethodsWe established a Markov model to compare the cost-effectiveness of perioperative pembrolizumab with that of neoadjuvant chemotherapy in 21-day cycles, utilizing data from the phase 3 KEYNOTE-671 trial. Additional data were extracted from other publications or online sources. Sensitivity analyses were conducted to evaluate the robustness of the findings. A willingness-to-pay threshold of $150,000 per quality-adjusted life-years (QALYs) gained was established. The main outcomes of this study were the measurement of QALYs, overall costs, incremental cost-effectiveness ratio (ICER), and net monetary benefit (NMB).ResultsDuring a 10-year time horizon, the total costs of perioperative pembrolizumab and the control treatment were $224,779.1 and $110,026.3, respectively. The QALYs were 4.19 and 2.97 for the two treatments, respectively, which led to an ICER of $94,222.29 per QALY gained. The NMB at the WTP threshold at $150,000 per QALY gained was $67,931.3. One-way sensitivity analysis identified the cost of pembrolizumab as the primary factor influencing cost-effectiveness. Probabilistic sensitivity analysis indicated a 97.7% probability of perioperative pembrolizumab being cost-effective at the WTP threshold.ConclusionsFrom the perspective of the United States healthcare payers, perioperative pembrolizumab is a cost-effective treatment for patients with early-stage NSCLC.

【 授权许可】

Unknown   
Copyright © 2023 Tian, Niu, Wang, Lu, Xiao, Deng, Tanzhu and Zhou