A Cost-Effectiveness Analysis of Adjuvant Pembrolizumab in the Treatment of Patients With Early-Stage (Stages IB-III) Non-Small Cell Lung Cancer (NSCLC) Following Complete Resection and Platinum-Based Chemotherapy

OBJECTIVES:

Lung cancer is one of the most prevalent cancers and the leading cause of cancer-related mortality in Greece. Adjuvant platinum-based chemotherapy following surgical resection is the standard of care (SoC) for patients with stages II-III NSCLC. However, survival among these patients remains poor. Pembrolizumab has been approved for the adjuvant treatment of early-stage NSCLC patients with high risk of recurrence (following complete resection and platinum-based chemotherapy. This analysis aims to estimate the cost-effectiveness of Pembrolizumab vs SoC in the adjuvant NSCLC setting in Greece.

METHODS:

A cost-effectiveness model was developed using a Markov cohort structure, consisting of four mutually exclusive health-states (disease-free, locoregional recurrence, distant metastases, and death). The model was developed using the Greek payer perspective over a lifetime horizon. Efficacy and safety data were derived based on patient-level data from the KEYNOTE-091 trial, clinical trials in metastatic NSCLC, and U.S. real-world data, whereas drug acquisition and healthcare resource utilization data were obtained from the literature and official public sources. An annual discount of 3% was applied to both costs and outcomes. Model uncertainty and robustness were assessed through one-way (OWSA) and probabilistic (PSA) sensitivity analyses.

RESULTS:

Total costs for pembrolizumab and SoC were €244,339 and €213,144, respectively. Total life-years were estimated at 9.37 for Pembrolizumab versus 8.24 for SoC, whereas total quality-adjusted life years (QALYs) were estimated at 7.62 and 6.70 for Pembrolizumab and SoC, respectively. The Incremental cost-effectiveness ratio was calculated at €33,880/QALY for pembrolizumab vs. SoC, which is below the Greek willingness-to-pay threshold of €52,770 (as per WHO: 3xGDP/Capita). Both the OWSA and PSA confirmed the robustness of the results.

CONCLUSIONS:

From the Greek payer perspective, the present model suggests Pembrolizumab to be a cost-effective treatment option for NSCLC patients with high risk of recurrence following complete resection and platinum-based chemotherapy.