Cost-effectiveness of Pembrolizumab versus Carboplatin-based Chemotherapy as First-line Treatment of PD-L1-positive Locally Advanced or Metastatic Urothelial Carcinoma Ineligible for Cisplatin-based Therapy in the United States
| Autor: | Karl Patterson, Oliver Hale, Blanca Homet Moreno, Yang Meng, Yizhen Lai, Haojie Li, Ronac Mamtani, James Luke Godwin |
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| Rok vydání: | 2020 |
| Předmět: |
Oncology
medicine.medical_specialty Metastatic Urothelial Carcinoma Lung Neoplasms Cost effectiveness Urology medicine.medical_treatment Cost-Benefit Analysis Network Meta-Analysis 030232 urology & nephrology Pembrolizumab Antibodies Monoclonal Humanized B7-H1 Antigen Carboplatin 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Antineoplastic Agents Immunological Internal medicine Antineoplastic Combined Chemotherapy Protocols Medicine Humans Cisplatin Chemotherapy Carcinoma Transitional Cell Bladder cancer business.industry medicine.disease Gemcitabine United States chemistry Urinary Bladder Neoplasms 030220 oncology & carcinogenesis business medicine.drug |
| Zdroj: | Clinical genitourinary cancer. 19(1) |
| ISSN: | 1938-0682 |
| Popis: | Introduction Pembrolizumab has been approved in the United States (US) for the first-line treatment of patients with advanced or metastatic urothelial carcinoma, who are ineligible for cisplatin-containing chemotherapy and with tumors expressing programmed death-ligand 1 (PD-L1) (Combined Positive Score ≥ 10), or ineligible for any platinum-containing chemotherapy regardless of PD-L1 status. Long-term KEYNOTE-052 data continue to demonstrate pembrolizumab’s meaningful, durable, and well-tolerated antitumor activity. This study evaluates the cost-effectiveness of pembrolizumab versus carboplatin plus gemcitabine as first-line treatment for cisplatin-ineligible patients who have PD-L1–positive tumors from a US third-party healthcare payer’s perspective. Patients and Methods A partitioned survival model containing 3 health states (progression-free, progressed, and death) was developed. A simulated treatment comparison and a network meta-analysis were conducted to estimate the comparative efficacy of pembrolizumab versus carboplatin-based chemotherapy. Overall survival, progression-free survival, time on treatment, adverse events, and utilities were modeled using the final analyses of the KEYNOTE-052 trial and 4 studies for carboplatin plus gemcitabine. Cost data were estimated using US standard sources and real-world data. Deterministic, probabilistic, and scenario analyses were conducted to assess the robustness of the results. Results Over 20 years, pembrolizumab resulted in a mean gain of 2.58 life-years, 2.01 quality-adjusted life-years, and additional costs of $158,561, leading to an incremental cost-effectiveness ratio of $78,925/quality-adjusted life-year compared with carboplatin plus gemcitabine. Conclusion This study suggests that pembrolizumab is cost-effective compared with carboplatin plus gemcitabine as a first-line therapy for patients with advanced or metastatic urothelial carcinoma who are PD-L1–positive. |
| Databáze: | OpenAIRE |
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