Abstract
BackgroundThe clinical trial of Keynote-604 showed that pembrolizumab plus chemotherapy could generate clinical benefits for extensive-stage small-cell lung cancer (ES-SCLC). We aim to assess the efficacy and cost of pembrolizumab combined with chemotherapy in the first-line treatment setting of ES-SCLC from the United States (US) payers’ perspective.MethodsA synthetical Markov model was used to evaluate cost and effectiveness of pembrolizumab plus platinum-etoposide(EP) versus EP in first-line therapy for ES-SCLC from the data of Keynote-604. Lifetime costs life-years(LYs), quality adjusted LYs(QALYs) and incremental cost-effectiveness ratios(ICERs) were estimated. One-way and probabilistic sensitivity analyses were performed. Furthermore, we performed subgroup analysis.ResultsPembrolizumab plus EP resulted in additional 0.18 QALYs(0.32 LYs) and corresponding incremental costs $113,625, resulting an ICER of $647,509 per QALY versus EP. The price of pembrolizumab had a significant impact on ICER. Probabilistic sensitivity analysis indicated that pembrolizumab combined chemotherapy may become a cost-effective option with a probability of 0%. Besides, subgroup analysis suggested that all subgroups were not cost-effective.ConclusionFrom the perspective of the US payer, pembrolizumab plus EP is not a cost-effective option for first-line treatment patients with ES-SCLC at a WTP threshold of $150,000 per QALY.
Highlights
The clinical trial of Keynote-604 showed that pembrolizumab plus chemotherapy could generate clinical benefits for extensive-stage small-cell lung cancer (ES-Small-cell lung cancer (SCLC))
The use of pembrolizumab plus etoposide and platinum (EP) cost an additional $113,625, resulting in an ICER of $346,818 per LY, or $647,509 per QALY compared with EP (Table 2)
The ICER scatter diagram (Additional file 1: Fig. S3) showed that the probability sensitivity analysis and pembrolizumab plus EP cannot be effective at the WTP threshold of $150,000 per QALY
Summary
The clinical trial of Keynote-604 showed that pembrolizumab plus chemotherapy could generate clinical benefits for extensive-stage small-cell lung cancer (ES-SCLC). Pembrolizumab is a selective, high-affinity, programmatic, specific, human immunoglobulin G4 monoclonal antibody that binds to the programmed death 1 receptor. In the first line treatment of patients with ES-SCLC, the randomized phase 3 trial Keynote-604 further demonstrated the efficacy of the combination of pembrolizumab with chemotherapy. It showed that pembrolizumab plus EP therapy prolonged overall survival (OS 10.8 vs 9.7 months; hazard ratio [HR] 0.8; 95% CI 0.64 to 0.98; p = 0.0164) and significantly extended the progression-free survival (PFS 4.5 vs 4.3 months; HR 0.75; 95% CI 0.61 to 0.91; p = 0.0023) compared to EP therapy [10]
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