Weiting Liao1,2, Jiaxing Huang1,2, David Hutton3, Qiu Li1,2. 1. a Department of Medical Oncology , Cancer Center, West China Hospital, Sichuan University , Chengdu 610041 , PR China. 2. b West China Biomedical Big Data Center, Sichuan University , Chengdu 610041 , PR China. 3. c Department of Health Management and Policy , University of Michigan , Ann Arbor , MI 48109 , USA.
Abstract
PURPOSE: Pembrolizumab was recently approved in several countries as a first-line treatment for patients with PD-L1 positive, non-small cell lung cancer (NSCLC). However, it is expensive. This study aimed to assess the cost-effectiveness of pembrolizumab in treating advanced NSCLC patients with PD-L1 positive cancer in China. METHODS: A Markov model was developed to compare the cost-effectiveness of pembrolizumab with chemotherapy for patients with PD-L1 expression on at least 50% of NSCLC tumor cells. Model inputs for transition probabilities and toxicity were derived from published clinical trial data, while health utilities were estimated from a literature review. Costs for drugs were updated to standard fee data from West China Hospital in 2017. Health outcomes were measured in quality-adjusted life years (QALYs), and cost-effectiveness was measured as the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were conducted to test the robustness of the model. RESULTS: Pembrolizumab gained 0.45 QALYs at an incremental cost of $46,362 compared to chemotherapy for an ICER of $103,128 per QALY gained. In most scenarios, the ICER exceeded three times the Chinese Gross Domestic Product per capita. Two-way sensitivity analysis showed that, when the utility of the progression-free status increased to the maximal value of 0.845 and the 1 mg dose price decreased to $10.50, the ICER reduced to $25,216/QALY. CONCLUSIONS: Pembrolizumab is not likely to be cost-effective in the treatment of PD-L1 positive, NSCLC for Chinese patients. Less aggressive pricing may increase accessibility for patients in China.
PURPOSE:Pembrolizumab was recently approved in several countries as a first-line treatment for patients with PD-L1 positive, non-small cell lung cancer (NSCLC). However, it is expensive. This study aimed to assess the cost-effectiveness of pembrolizumab in treating advanced NSCLCpatients with PD-L1 positive cancer in China. METHODS: A Markov model was developed to compare the cost-effectiveness of pembrolizumab with chemotherapy for patients with PD-L1 expression on at least 50% of NSCLC tumor cells. Model inputs for transition probabilities and toxicity were derived from published clinical trial data, while health utilities were estimated from a literature review. Costs for drugs were updated to standard fee data from West China Hospital in 2017. Health outcomes were measured in quality-adjusted life years (QALYs), and cost-effectiveness was measured as the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were conducted to test the robustness of the model. RESULTS:Pembrolizumab gained 0.45 QALYs at an incremental cost of $46,362 compared to chemotherapy for an ICER of $103,128 per QALY gained. In most scenarios, the ICER exceeded three times the Chinese Gross Domestic Product per capita. Two-way sensitivity analysis showed that, when the utility of the progression-free status increased to the maximal value of 0.845 and the 1 mg dose price decreased to $10.50, the ICER reduced to $25,216/QALY. CONCLUSIONS:Pembrolizumab is not likely to be cost-effective in the treatment of PD-L1 positive, NSCLC for Chinese patients. Less aggressive pricing may increase accessibility for patients in China.
Entities:
Keywords:
A13; C18; Cost-effectiveness; immunotherapy; non-small cell lung cancer
Authors: Oscar Arrieta; Feliciano Barrón; Laura Alejandra Ramírez-Tirado; Zyanya Lucia Zatarain-Barrón; Andrés F Cardona; Diego Díaz-García; Masao Yamamoto Ramos; Beatriz Mota-Vega; Amir Carmona; Marco Polo Peralta Álvarez; Yolanda Bautista; Fernando Aldaco; Raquel Gerson; Christian Rolfo; Rafael Rosell Journal: JAMA Oncol Date: 2020-06-01 Impact factor: 31.777