Cost Effectiveness of Pembrolizumab vs. Standard-of-Care Chemotherapy as First-Line Treatment for Metastatic NSCLC that Expresses High Levels of PD-L1 in the United States

被引:111
作者
Huang, Min [1 ]
Lou, Yanyan [2 ]
Pellissier, James [1 ]
Burke, Thomas [1 ]
Liu, Frank Xiaoqing [1 ]
Xu, Ruifeng [1 ]
Velcheti, Vamsidhar [3 ]
机构
[1] Merck & Co Inc, Ctr Observat & Real World Evidence, 2000 Galloping Hill Rd, Kenilworth, NJ 07033 USA
[2] Mayo Clin, Dept Hematol & Oncol, 4500 San Pablo Rd, Jacksonville, FL USA
[3] Cleveland Clin, Solid Tumor Oncol, 9500 Euclid Ave,Mail Code R35, Cleveland, OH 44195 USA
关键词
PARTITIONED SURVIVAL MODELS; CELL LUNG-CANCER; TREATMENT PATTERNS; HEALTH; DISEASE; LIFE; 2ND;
D O I
10.1007/s40273-017-0527-z
中图分类号
F [经济];
学科分类号
02 ;
摘要
Objectives Our objectives were to evaluate the cost effectiveness of pembrolizumab compared with standard-of-care (SoC) platinum-based chemotherapy as first-line treatment in patients with metastatic non-small-cell lung cancer (NSCLC) that expresses high levels of programmed death ligand-1 (PD-L1) [tumour proportion score (TPS) >= 50%], from a US third-party public healthcare payer perspective. Methods We conducted a partitioned-survival model with a cycle length of 1 week and a base-case time horizon of 20 years. Parametric models were fitted to Kaplan-Meier estimates of time on treatment, progression-free survival and overall survival from the KEYNOTE-024 randomized clinical trial (patients aged >= 18 years with stage IV NSCLC, TPS >= 50%, without epidermal growth factor receptor (EGFR)-activating mutations or anaplastic lymphoma kinase (ALK) translocations who received no prior systemic chemotherapy) and validated with long-term registry data. Quality-adjusted life-years (QALYs) were calculated based on EuroQoL-5 Dimensions (EQ-5D) utility data collected in the trial. Costs ($US, year 2016 values) for drug acquisition/administration, adverse events and clinical management were included. Costs and outcomes were discounted at 3% per year. A series of deterministic and probabilistic sensitivity analyses were performed to test the robustness of the results. Results In the base-case scenario, pembrolizumab resulted in an expected gain of 1.31 life-years (LYs) and 1.05 QALYs and an incremental cost of $US102,439 compared with SoC. The incremental cost per QALY gain was $US97,621/QALY and the incremental cost per LY gain was $US78,344/LY. Conclusions Pembrolizumab is projected to be a cost-effective option compared with SoC platinum-based chemotherapy as first-line treatment in adults with metastatic NSCLC expressing high levels of PD-L1.
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页码:831 / 844
页数:14
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