Cost-effectiveness of neoadjuvant pembrolizumab plus chemotherapy with adjuvant pembrolizumab for early-stage non-small cell lung cancer in the United States

Wentao Tian; Lishui Niu; Ziqi Wang; Ruoyu Lu; Gang Xiao; Fuxing Deng; Guilong Tanzhu; Rongrong Zhou

doi:10.3389/fimmu.2023.1268070

Cost-effectiveness of neoadjuvant pembrolizumab plus chemotherapy with adjuvant pembrolizumab for early-stage non-small cell lung cancer in the United States

Front Immunol. 2023 Sep 26:14:1268070. doi: 10.3389/fimmu.2023.1268070. eCollection 2023.

Authors

Wentao Tian¹, Lishui Niu¹, Ziqi Wang¹, Ruoyu Lu¹, Gang Xiao¹, Fuxing Deng¹, Guilong Tanzhu¹, Rongrong Zhou^{1

2

3}

Affiliations

¹ Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
² Xiangya Lung Cancer Center, Xiangya Hospital, Central South University, Changsha, China.
³ National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.

Abstract

Introduction: Perioperative (neoadjuvant and adjuvant) pembrolizumab has shown favorable efficacy in patients with early-stage non-small cell lung cancer (NSCLC). This study aims to evaluate the cost-effectiveness of this treatment from the perspective of the United States healthcare payers.

Methods: We established a Markov model to compare the cost-effectiveness of perioperative pembrolizumab with that of neoadjuvant chemotherapy in 21-day cycles, utilizing data from the phase 3 KEYNOTE-671 trial. Additional data were extracted from other publications or online sources. Sensitivity analyses were conducted to evaluate the robustness of the findings. A willingness-to-pay threshold of $150,000 per quality-adjusted life-years (QALYs) gained was established. The main outcomes of this study were the measurement of QALYs, overall costs, incremental cost-effectiveness ratio (ICER), and net monetary benefit (NMB).

Results: During a 10-year time horizon, the total costs of perioperative pembrolizumab and the control treatment were $224,779.1 and $110,026.3, respectively. The QALYs were 4.19 and 2.97 for the two treatments, respectively, which led to an ICER of $94,222.29 per QALY gained. The NMB at the WTP threshold at $150,000 per QALY gained was $67,931.3. One-way sensitivity analysis identified the cost of pembrolizumab as the primary factor influencing cost-effectiveness. Probabilistic sensitivity analysis indicated a 97.7% probability of perioperative pembrolizumab being cost-effective at the WTP threshold.

Conclusions: From the perspective of the United States healthcare payers, perioperative pembrolizumab is a cost-effective treatment for patients with early-stage NSCLC.

Keywords: adjuvant; cost-effectiveness; early-stage; neoadjuvant; non-small cell lung cancer; pembrolizumab.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adjuvants, Immunologic / therapeutic use
Adjuvants, Pharmaceutic
Carcinoma, Non-Small-Cell Lung* / drug therapy
Cost-Benefit Analysis
Humans
Lung Neoplasms* / drug therapy
Neoadjuvant Therapy
Small Cell Lung Carcinoma*
United States

Substances

pembrolizumab
Adjuvants, Immunologic
Adjuvants, Pharmaceutic

Grants and funding

The authors declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the National Multidisciplinary Cooperative Diagnosis and Treatment Capacity Building Project for Major Diseases (Lung Cancer, grant number: z027002), Natural Science Foundation of Hunan Province (2022JJ30992), Chen Xiao-Ping Foundation for the Development of Science and Technology of Hubei Province (CXPJJH121005-01).