Abstract
ObjectivesA new patient assistance program (PAP) for pembrolizumab was started in China in 2021. The researchers aimed to evaluate the economic outcomes of pembrolizumab plus pemetrexed and platinum versus chemotherapy alone in the first-line treatment of patients with metastatic non-squamous non-small cell lung cancer, based on the pricing mechanism of PAP.Material and MethodsSurvival analysis and partitioned survival model were performed to evaluate the incremental cost-effectiveness ratio (ICER) in the pembrolizumab group compared with the chemotherapy group. Survival probabilities were extracted from the data of the KEYNOTE-189 trial. Cost and utility data were gathered from published literature. The pricing mechanism of PAP was set in each cycle in the partitioned survival model, according to the progression-free survival (PFS) data of the KEYNOTE-189 trial, which included PFS-1 and PFS-2. Deterministic sensitivity analysis and probabilistic sensitivity analysis were conducted.ResultsThe ICER of the pembrolizumab group versus chemotherapy group was $65,272/quality-adjusted life year (QALY), which still exceeded the willingness-to-pay threshold of three times per capita gross domestic product (GDP) of China ($33,581.22), although PAP was calculated. Sensitivity analysis implied that the price of chemotherapeutic drugs combined with pembrolizumab was one of the main influencing factors of ICER.ConclusionsDue to various prices set by PAP and the payment for combined chemotherapy, the economic advantage of pembrolizumab plus chemotherapy in the first-line treatment of non-small cell lung cancer (NSCLC) is still not achieved in China.
Highlights
Lung cancer is currently one of the most malignant tumors with the highest incidence and mortality worldwide
Even though patient assistance program (PAP) was considered, the incremental cost-effectiveness ratio (ICER) remained more than the threshold of three times the gross domestic product (GDP) per capita ($33,581.22).Considering net benefit, the net monetary benefits (NMB) of patients in the pembrolizumab group and placebo group were $ -53,078.3 and $ -32,796.2, respectively (Table 3)
The results of the deterministic sensitivity analyses were presented in a Tornado diagram, which indicated that the price of pemetrexed, utility of progression-free survival (PFS), and discount rate were the main influencing factors of ICER
Summary
Lung cancer is currently one of the most malignant tumors with the highest incidence and mortality worldwide. On April 2, 2019, the National Medical Products Administration (NMPA) of the People’s Republic of China approved pembrolizumab combined with pemetrexed and cisplatin chemotherapy as first-line treatment of metastatic nonsquamous NSCLC, without sensitizing EGFR or ALK mutations. On September 30, 2019, NMPA approved pembrolizumab as a single agent for the first-line treatment of locally advanced or metastatic NSCLC with PD-L1 TPS ≥ 1%, without sensitizing EGFR or ALK mutations. Patients’ lives are prolonged, the expensive price of Abbreviations: PAP, Patient assistance program; ICER, Incremental costeffectiveness ratio; PFS, Progression-free survival; QALY, Quality-adjusted life year; GDP, Gross domestic product; NSCLC, Non-small-cell lung cancer; SCLC, Small-cell lung cancer; NMPA, National Medical Products Administration; OS, Overall-survival; AIC, Akaike information criterion; BIC, Bayesian information criterion; PD, Progressive disease; DSA, Deterministic sensitivity analyses; PSA, Probabilistic sensitivity analyses; ACER, Average cost-effectiveness ratio; NMB, Net monetary benefit
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