Sarah A Ackroyd1, Elbert S Huang2, Katherine C Kurnit3, Nita K Lee3. 1. University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, 5841 S Maryland Ave, Chicago, IL 60637, USA. Electronic address: Sarah.Ackroyd@uchospitals.edu. 2. University of Chicago Medicine, Department of Medicine, Section of General Internal Medicine, Center for Chronic Disease Research and Policy, 5841 S Maryland Ave, Chicago, IL 60637, USA. 3. University of Chicago Medicine, Department of Obstetrics and Gynecology, Section of Gynecologic Oncology, 5841 S Maryland Ave, Chicago, IL 60637, USA.
Abstract
OBJECTIVE: To determine the cost effectiveness of pembrolizumab/lenvatinib (P/L) versus standard-of-care carboplatin/paclitaxel (C/T) as first-line systemic therapy for patients with advanced/recurrent endometrial cancer. METHODS: We designed a Markov model to simulate treatment outcomes for advanced/recurrent endometrial cancer patients whose tumors are either microsatellite stable (MSS) or have high microsatellite instability (MSI-high). We adopted a healthcare sector perspective for the analysis. Model inputs for costs, health utility, and clinical estimates were obtained from the literature including data from GOG0209 and KEYNOTE-146. Primary outcomes included costs of care, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). The time-horizon was three years and the discount rate was 3% annually. RESULTS: In a MSS cohort, compared to C/T, first-line treatment with P/L increased treatment costs by $212,670 and decreased QALYs by 0.28 per patient. In a MSI-high cohort, compared to C/T, P/L increased costs by $313,487 and increased QALYs by 0.11 per patient, representing an ICER of $2,849,882 per QALY. Sensitivity analyses found that the price of the new drugs was the most important determinant of the ICER and that the price of the new drugs would need to decrease by 85% to $2817 per cycle to reach a $150,000/QALY threshold. CONCLUSION: In the MSS model, we found that first-line therapy for advanced or recurrent endometrial cancer with P/L increased costs and worsened outcomes compared to C/T. In the MSI-high model, P/L improved survival and QALYs compared to C/T but was not cost-effective at the current cost of the drugs.
OBJECTIVE: To determine the cost effectiveness of pembrolizumab/lenvatinib (P/L) versus standard-of-care carboplatin/paclitaxel (C/T) as first-line systemic therapy for patients with advanced/recurrent endometrial cancer. METHODS: We designed a Markov model to simulate treatment outcomes for advanced/recurrent endometrial cancer patients whose tumors are either microsatellite stable (MSS) or have high microsatellite instability (MSI-high). We adopted a healthcare sector perspective for the analysis. Model inputs for costs, health utility, and clinical estimates were obtained from the literature including data from GOG0209 and KEYNOTE-146. Primary outcomes included costs of care, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). The time-horizon was three years and the discount rate was 3% annually. RESULTS: In a MSS cohort, compared to C/T, first-line treatment with P/L increased treatment costs by $212,670 and decreased QALYs by 0.28 per patient. In a MSI-high cohort, compared to C/T, P/L increased costs by $313,487 and increased QALYs by 0.11 per patient, representing an ICER of $2,849,882 per QALY. Sensitivity analyses found that the price of the new drugs was the most important determinant of the ICER and that the price of the new drugs would need to decrease by 85% to $2817 per cycle to reach a $150,000/QALY threshold. CONCLUSION: In the MSS model, we found that first-line therapy for advanced or recurrent endometrial cancer with P/L increased costs and worsened outcomes compared to C/T. In the MSI-high model, P/L improved survival and QALYs compared to C/T but was not cost-effective at the current cost of the drugs.
Authors: Lindsey E Minion; Jiaru Bai; Bradley J Monk; L Robin Keller; Eskander N Ramez; Gareth K Forde; John K Chan; Krishnansu S Tewari Journal: Gynecol Oncol Date: 2015-03-10 Impact factor: 5.482
Authors: Scott Wadler; Donna E Levy; Sarah T Lincoln; Gamini S Soori; Julian C Schink; Gary Goldberg Journal: J Clin Oncol Date: 2003-06-01 Impact factor: 44.544
Authors: Amanda N Fader; Dana M Roque; Eric Siegel; Natalia Buza; Pei Hui; Osama Abdelghany; Setsuko Chambers; Angeles Alvarez Secord; Laura Havrilesky; David M O'Malley; Floor J Backes; Nicole Nevadunsky; Babak Edraki; Dirk Pikaart; William Lowery; Karim ElSahwi; Paul Celano; Stefania Bellone; Masoud Azodi; Babak Litkouhi; Elena Ratner; Dan-Arin Silasi; Peter E Schwartz; Alessandro D Santin Journal: Clin Cancer Res Date: 2020-06-29 Impact factor: 12.531