Lenvatinib plus pembrolizumab in advanced recurrent endometrial cancer: a cost-effectiveness analysis

Abstract

Objectives: To determine the cost-effectiveness of lenvatinib plus pembrolizumab (LP) in patients with endometrial cancer without microsatellite instability who failed first-line chemotherapy. Methods: A decision analysis model was created to evaluate the cost-effectiveness of LP relative to doxorubicin, pegylated liposomal doxorubicin (PLD), and bevacizumab in patients with recurrent microsatellite stable endometrial cancer who failed first-line chemotherapy. Clinical estimates were obtained from published data and drug cost estimates were obtained using average wholesale prices. Additional cost estimates were utilized to estimate cost of grade 3-4 toxicity treatment. The measure of effectiveness was quality-adjusted life years (QALYs). Due to the high rate of toxicity in the LP group, a health state utility (HSU) penalty of -0.05 was applied to this group. Incremental cost-effectiveness ratios (ICERs) were calculated to determine the cost per QALY. The willingness to pay threshold (WTP) was set at $100,000 per QALY saved. Sensitivity analyses were performed on cost, effectiveness, and HSU penalty for LP. Results: Costs of treatment with doxorubicin, PLD, and bevacizumab are $26.7 million (M), $51.1 M, and $225.1 M respectively. Cost of treatment with LP is $856.5M. Relative to doxorubicin, the ICER for PLD, bevacizumab, and LP are $46,279, $345,824, and $726,483 respectively. Two-way sensitivity analysis varying the cost of LP show that if the combined cost of these two drugs decreases from over $34,000 per cycle to less than $9,000 per cycle, this strategy would be cost-effective. At the current cost, even if the median overall survival was double the 16.7 months used in the base model, the ICER for LP remains above the WTP threshold. Eliminating the HSU penalty for LP decreased the ICER $567,000 while increasing the penalty to 0.10 increased the ICER to over $1M. Conclusions: LP is not cost-effective in patients with recurrent, MSS endometrial cancer who have failed first line therapy. A dramatic reduction in cost of LP is required for this novel strategy to be cost-effective. To determine the cost-effectiveness of lenvatinib plus pembrolizumab (LP) in patients with endometrial cancer without microsatellite instability who failed first-line chemotherapy. A decision analysis model was created to evaluate the cost-effectiveness of LP relative to doxorubicin, pegylated liposomal doxorubicin (PLD), and bevacizumab in patients with recurrent microsatellite stable endometrial cancer who failed first-line chemotherapy. Clinical estimates were obtained from published data and drug cost estimates were obtained using average wholesale prices. Additional cost estimates were utilized to estimate cost of grade 3-4 toxicity treatment. The measure of effectiveness was quality-adjusted life years (QALYs). Due to the high rate of toxicity in the LP group, a health state utility (HSU) penalty of -0.05 was applied to this group. Incremental cost-effectiveness ratios (ICERs) were calculated to determine the cost per QALY. The willingness to pay threshold (WTP) was set at $100,000 per QALY saved. Sensitivity analyses were performed on cost, effectiveness, and HSU penalty for LP. Costs of treatment with doxorubicin, PLD, and bevacizumab are $26.7 million (M), $51.1 M, and $225.1 M respectively. Cost of treatment with LP is $856.5M. Relative to doxorubicin, the ICER for PLD, bevacizumab, and LP are $46,279, $345,824, and $726,483 respectively. Two-way sensitivity analysis varying the cost of LP show that if the combined cost of these two drugs decreases from over $34,000 per cycle to less than $9,000 per cycle, this strategy would be cost-effective. At the current cost, even if the median overall survival was double the 16.7 months used in the base model, the ICER for LP remains above the WTP threshold. Eliminating the HSU penalty for LP decreased the ICER $567,000 while increasing the penalty to 0.10 increased the ICER to over $1M. LP is not cost-effective in patients with recurrent, MSS endometrial cancer who have failed first line therapy. A dramatic reduction in cost of LP is required for this novel strategy to be cost-effective.