Introduction
Until recently, chemotherapy was the only treatment option for metastatic non-squamous non-small cell lung cancer (NSCLC) without targetable mutations. The introduction of immunotherapies changed the prognosis for patients suffering from this disease. Pembrolizumab can be given as monotherapy or in combination with chemotherapy. So far, it was unclear, if and which of these treatment options is cost-effective for patients with a high programmed death ligand 1 (PD-L1) expression.
Methods
We conducted a cost-effectiveness analysis for Switzerland, comparing pembrolizumab with and without chemotherapy and chemotherapy alone using a Markov model with a time horizon of 10 years. We used data from the KN-024 and KN-189 registration trials and the available follow-up data. Costs were assessed from a Swiss health care perspective and include further treatment lines as well as best-supportive care.
Results
Pembrolizumab monotherapy in comparison to chemotherapy lead to a gain of 0.83 quality-adjusted life years (QALYs) and generates incremental costs of 56,585 CHF per year, resulting in an incremental cost-effectiveness ratio (ICER) of 68,580 CHF/QALY. Pembrolizumab in combination with chemotherapy resulted in a gain of 0.17 QALYs and generated incremental costs of 81,085 CHF as compared to pembrolizumab alone, resulting in an ICER of 475,299 CHF/QALY.
Conclusion
While pembrolizumab monotherapy is cost-effective from a Swiss perspective, the combination therapy with pembrolizumab and chemotherapy is not.
Keywords
cost-effectiveness, Pembrolizumab, NSCLC
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