Cost-Effectiveness of Pembrolizumab as First-Line Treatment for Patients With MSI-H or dMMR Unresectable or Metastatic Colorectal Cancer From Public Perspective in Mexico

OBJECTIVES: This study evaluated the cost-effectiveness of pembrolizumab monotherapy vs. standard of care (SoC) as per KEYNOTE-177 Phase 3 trial and other 1L treatments for MSI-H/dMMR CRC from a Mexican public healthcare system perspective.

METHODS: A five-stage Markov model was developed including progression free, post-surgery progression free, post-surgery progressed disease, progressed disease, and death, and using efficacy and safety data from KEYNOTE-177 trial based on IA2. Treatment costswere obtained from Instituto Mexicano del Seguro Social and is available in the official journal of the federation (DOF, by its abbreviation in Spanish). Acquisition and medical costs, and costs related to adverse events and subsequent therapies were obtained from main public institutions. A 5-year time horizon was adopted. Alternate scenarios were tested in the sensitivity analyses, performing 1000 iterations, demonstrating the robustness and reliability of the results.

RESULTS:

Pembrolizumab as monotherapy increases the total life years gained (LY) by 0.685 LY, mainly derived from increases in the progression free state (1.011 LYs), post-surgery progression free (0.014 LYs), post-surgery progressed disease (0.011 LYs) and a decrease in progressed disease state (0.351 LYs). This translates to a total cost of pembrolizumab of $161,863.67 USD Vs $145,091.17 USD for SoC, with an incremental cost of $16,773 USD, resulting in an incremental cost-effectiveness ratio (ICER) of $24,492 USD per LY, which is equivalent to 1.68 GDP per capita (1 GDP is equal to $14,536.94). Results were robust and consistent in sensitivity analyses.

CONCLUSIONS:

Pembrolizumab is cost-effective as first-line treatment for patients with unresectable or metastatic MSI-H/dMMR colorectal cancer in Mexico, compared with standard of care.