PCN175 COST-EFFECTIVENESS ANALYSIS OF PEMBROLIZUMAB VERSUS CHEMOTHERAPY AS FIRST-LINE TREATMENT FOR METASTATIC NON-SMALL CELL LUNG CANCER WITH DIFFERENT PD-L1 EXPRESSION LEVELS IN CHINA USING BOTH PARTITION SURVIVAL AND MARKOV MODELS

Abstract

To evaluate the cost-effectiveness of pembrolizumab versus chemotherapy as the first-line treatment for metastatic non-small cell lung cancer (NSCLC) with different tumor proportion scores (TPS), from perspective of payers in China. Both partition survival (PS) and Markov models, comprised of three health states were constructed to estimate the life-time incremental cost-effectiveness ratio (ICER). Subgroup analyses were performed in three PD-L1 TPS populations (≥50%, ≥20% and ≥1%). Reconstructed individual patient data were derived from published Kaplan–Meier curves in pivotal trial KEYNOTE-042. Utilities came from the value of the Chinese population in the published literature. Cost were collected from official websites. Sensitivity analyses were conducted to verify the robustness of the results. The scenario analysis of the patient assistance project (PAP) price was also carried out. The result of PS model was more favorable to the population with a disease progression advantage (TPS≥50%) CNY 228,254.12/ QALY compared with markov result CNY 279,649.16/ QALY. Patients with TPS≥20% and TPS≥1% were the markov model results had smaller ICER, CNY 340,402.80/ QALY and CNY 244,495.54/ QALY. ICERs yield by pembrolizumab monotherapy among different TPS populations were beyond the local threshold of 3 times GDP per capita in 2018 (CNY 193,932.00). However, when the PAP price (52% discount) was implemented, the economics of the results reversed. Compared to standard chemotherapy, pembrolizumab is not a cost-effective choice for patients with locally advanced or metastatic NSCLC from the perspective of Chinese payer, regardless of TPS. Deeper discount of its current price or be funded publicly by special arrangements would make pembrolizumab a preferable choice.