Pembrolizumab for persistent, recurrent, or metastatic cervical cancer: a cost-effectiveness analysis (025)

Abstract

<b>Objectives:</b> To determine the cost-effectiveness of pembrolizumab in patients with persistent, recurrent, or metastatic cervical cancer. <b>Methods:</b> A decision analysis model was created to evaluate the cost-effectiveness of platinum-based chemotherapy plus bevacizumab and pembrolizumab (CBP) relative to chemotherapy plus pembrolizumab (CP) and chemotherapy plus bevacizumab (CB). Published data from KEYNOTE-826 was used to estimate quality-adjusted life-years (QALYs), and drug cost estimates were obtained using average wholesale prices. Incremental cost-effectiveness ratios (ICERs) were calculated to determine cost/QALY. The willingness to pay (WTP) threshold was set at $100,000 per QALY saved. Sensitivity analyses were performed on cost and effectiveness for regimens containing pembrolizumab. <b>Results:</b> The cost of treatment with CB and CP were $416 million (M) and $713 M, respectively. The cost of treatment with CBP was $1.51 billion (B). Relative to CB, the ICER for CP was $92,678. CBP was dominated. Sensitivity analyses were performed varying the efficacy of CP and CBP. If overall survival (OS) after treatment with CP was less than 23.4 months, the ICER would exceed the WTP. If the OS from CP was assumed to be 20.4 months (midway between control and experimental arms of KEYNOTE-826), the ICER would increase to $183,039. If OS for CBP improved to 38 months, this regimen would be cost-effective. If CP is eliminated from the model, CBP becomes cost-effective relative to CB if the cost of pembrolizumab decreases from $12,080 to $2,913 per cycle. <b>Conclusions:</b> CP is cost-effective relative to CB for persistent, recurrent, or metastatic cervical cancer. In the baseline model, CBP was dominated. The efficacy of CBP would need to far exceed CP in order to be cost-effective. The cost-effectiveness of pembrolizumab-containing regimens improves with a decrease in drug cost. A closer look at the comparative efficacy between CP and CBP is needed to help inform treatment decisions for patients with persistent, recurrent, or metastatic cervical cancer.