Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Cost-Effectiveness Analysis of Pembrolizumab Plus Chemotherapy as First-Line Therapy for Extensive-Stage Small-Cell Lung Cancer in the United States

Version 1 : Received: 31 January 2021 / Approved: 1 February 2021 / Online: 1 February 2021 (18:10:59 CET)

How to cite: Liu, Q.; Luo, X.; Peng, L.; Yi, L.; Wan, X.; Li, J.; Zeng, X.; Tan, C. Cost-Effectiveness Analysis of Pembrolizumab Plus Chemotherapy as First-Line Therapy for Extensive-Stage Small-Cell Lung Cancer in the United States. Preprints 2021, 2021020068 (doi: 10.20944/preprints202102.0068.v1). Liu, Q.; Luo, X.; Peng, L.; Yi, L.; Wan, X.; Li, J.; Zeng, X.; Tan, C. Cost-Effectiveness Analysis of Pembrolizumab Plus Chemotherapy as First-Line Therapy for Extensive-Stage Small-Cell Lung Cancer in the United States. Preprints 2021, 2021020068 (doi: 10.20944/preprints202102.0068.v1).

Abstract

Background: The phase III KEYNOTE-604 study confirmed the benefit of pembrolizumab combined with chemotherapy in the first-line treatment of extensive-stage small-cell lung cancer(ES-SCLC). Intergrated the clinical benefits of pembrolizumab and its high cost into account, this study aim to assess the cost-effectiveness of adding pembrolizumab to standard first-line etoposide-platinum (EP) for patients with ES-SCLC from the the US payer perspective. Methods: A Markov model was developed to compared the costs and quality-adjusted life-years (QALYs) of pembrolizumab plus EP and placebo plus EP over a 10-year time horizon. Clinical efficacy, treatment utilization and safety data were pooled from the KEYNOTE-604 trial. Utilities were obtained from published resources. Costs were mainly collected from Medicare in 2020. Sensitivity analyses were performed to examined the robustness of our model. Results: Adding pembrolizumab to standard first-line EP, resulted in better effectiveness than the use of EP alone for ES-SCLC by 0.22 QALYs. Pembrolizumab plus EP was dominated economically by placebo plus EP, leading to an incremental cost-effectiveness ratio(ICER) of $334,373/ QALY. Deterministic sensitivity analyses indicated that the uncertainty in model parameters exerts no substantial effect on our results. Probability sensitivity analysis indicated that probabilities for pembrolizumab plus EP being cost-effective within a wide rang of willingness to pay were modest. Conclusion: From the US payer perspective, the first-line treatment for ES-SCLC with pembrolizumab plus EP was not cost-effective compare with placebo plus EP. Although pembrolizumab combination chemotherapy was beneficial to the survival of ES-SCLC, price reduction may be the necessary measure to improve its cost-effectiveness.

Keywords

cost-effectiveness; pembrolizumab; etoposide-platinum; extensive-stage small-cell lung cancer; small cell lung cancer.

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