Pembrolizumab vs the EXTREME Regimen in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: A Cost-Effectiveness Analysis.

Abstract

The KEYNOTE-048 clinical trial revealed that pembrolizumab improved the overall survival time of patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) vs cetuximab plus chemotherapy (EXTREME regimen). The current study examined the cost effectiveness of pembrolizumab monotherapy and pembrolizumab plus chemotherapy compared with the EXTREME regimen in patients with HNSCC from the perspectives of USA and China. A partitioned survival model was implemented for patients with R/M HNSCC, and the cost effectiveness of pembrolizumab monotherapy and pembrolizumab plus chemotherapy compared with the EXTREME regimen was compared. Survival information was derived from the KEYNOTE-048 trial. The model was designed as a 20-year time horizon, a 3-week cycle, and a 3% discount rate for costs and utilities. An incremental cost-effectiveness ratio (ICER) value less than $100,000/quality-adjusted life-year (QALY) was considered cost effective in the USA and $27,538/QALY in China. We analyzed the uncertainty by performing one-way and probabilistic sensitivity analyses. From the base-case analysis, we found that the pembrolizumab monotherapy scheme had a lower cost and better efficacy compared with the EXTREME regimen in the USA. In China, the ICER of the comparison was $62,401/QALY. The ICER of pembrolizumab plus chemotherapy vs the EXTREME regimen was $66,630/QALY in the USA and $90,538/QALY in China. The observations suggested that treatment with pembrolizumab monotherapy or pembrolizumab plus chemotherapy is a cost-effective strategy for patients with R/M HNSCC in the USA. However, the conclusion is the opposite for China: the EXTREME regimen is still a cost-effective choice.