Cost-effectiveness analysis of pembrolizumab versus chemotherapy as first-line treatment in locally advanced or metastatic non-small cell lung cancer with PD-L1 tumor proportion score 1% or greater

Autor: Yin Shi, Youwen Zhu, Dong Ding, Shan Zeng, David P. Carbone, Longjiang She, Linli Yao, Liangfang Shen, Xuefeng Xia, Mengting Liao, Huabin Hu, Jin Huang
Rok vydání: 2019
Předmět:
0301 basic medicine
Pulmonary and Respiratory Medicine
Oncology
Male
Cancer Research
medicine.medical_specialty
Lung Neoplasms
Cost effectiveness
medicine.medical_treatment
Cost-Benefit Analysis
Subgroup analysis
Pembrolizumab
Antibodies
Monoclonal
Humanized
B7-H1 Antigen
Disease-Free Survival
03 medical and health sciences
0302 clinical medicine
Antineoplastic Agents
Immunological
Internal medicine
Carcinoma
Non-Small-Cell Lung
Antineoplastic Combined Chemotherapy Protocols
medicine
Anaplastic lymphoma kinase
Humans
Neoplasm Metastasis
Lung cancer
Aged
Chemotherapy
business.industry
Cost-effectiveness analysis
medicine.disease
Markov Chains
United States
Quality-adjusted life year
030104 developmental biology
030220 oncology & carcinogenesis
Disease Progression
Female
Quality-Adjusted Life Years
business
Zdroj: Lung cancer (Amsterdam, Netherlands). 138
ISSN: 1872-8332
Popis: Objective The purpose of this study was to estimate the cost-effectiveness analysis of pembrolizumab versus chemotherapy as first-line treatment in locally advance or metastatic non-small cell lung cancer (NSCLC) with programmed death ligand 1 (PD-L1) tumor proportion score (TPS) 1% or greater from the United States (US) payer perspective. Materials and Methods This Markov structure was developed to estimate cost and effectiveness of pembrolizumab vs chemotherapy in the first-line treatment of locally advance or metastatic NSCLC based on the data from KEYNOTE-042. Cost and health outcomes were estimated at a willingness-to-pay (WTP) threshold of $150,000 per quality adjusted life year (QALY) in three PD-L1 TPS populations (≥50%, ≥20% and ≥1%). One-way, two-way and probabilistic sensitivity analysis were to test the model stability. Subgroup analysis were performed in three PD-L1 TPS populations (≥50%, ≥20% and ≥1%). Results The incremental costs and QALYs that pembrolizumab yielded, compared with chemotherapy, were $86164.87 and 0.63, $74562.25 and 0.46 and $70886.65 and 0.39 for the populations with a PD-L1 TPS ≥ 50%, TPS ≥ 20% and TPS ≥ 1%, leading an incremental cost-effective ratio (ICER) of $136,228.82, $160,625.98 and $179,530.17 per QALY, respectively. Conclusion First-line treatment with pembrolizumab is a cost-effective strategy compared with platinum-based chemotherapy when the value of WTP was $150,000 per QALY in locally advanced or metastatic NSCLC patients with PD-L1 TPS ≥ 50% and without epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutations, but not in the TPS ≥ 20% and 1% populations.
Databáze: OpenAIRE
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