Cost-Effectiveness of Pembrolizumab in 1L Recurrent/Metastatic Head and Neck Squamous Cell Cancer (R/M HNSCC) in Brazil
Author(s)
Monica M. Rojas, MD, PhD1, Thiago Paluan, MBA2, Mariana Rosim, PhD2, Andre Bergamim Almeida, BA2, Victoria Wurcel, MASc, MSc, MD3, Felype Castelhano, Student2, Srushti Gotarkar, MA4, Anubhav Patel, MSc4, Debosmita Bhadra, BSc, MA4, Anurag Kumar, MSc4, Sanjay Merchant, MBA, PhD5, Yuexin Tang, PhD5, Dandan Zheng, MS, PhD6, Rebekah H. Borse, MHS, PhD6;
1MSD Colombia, Bogotá, Colombia, 2MSD Brazil, São Paulo, Brazil, 3MSD Argentina, Buenos Aires, Argentina, 4CHEORS, North Wales, PA, USA, 5Merck & Co., Inc., Rahway, NJ, USA, 6Merck & Co., Inc., Rahway, PA, USA
1MSD Colombia, Bogotá, Colombia, 2MSD Brazil, São Paulo, Brazil, 3MSD Argentina, Buenos Aires, Argentina, 4CHEORS, North Wales, PA, USA, 5Merck & Co., Inc., Rahway, NJ, USA, 6Merck & Co., Inc., Rahway, PA, USA
Presentation Documents
OBJECTIVES: This study evaluated the cost-effectiveness of pembrolizumab either as monotherapy or in combination with platinum + 5- Fluorouracil (5-FU) versus cetuximab + platinum + 5-FU for the first line treatment of R/M HNSCC from a public healthcare system perspective in Brazil.
METHODS: A three-state partitioned survival model was developed consisting of two health states of progression-free and progressed disease, and a single state for death (all-causes), using efficacy and safety data from KEYNOTE-048 trial based on final analysis. Utility inputs were derived from the EQ-5D-3L data collected in KEYNOTE-048 using Brazilian algorithm. Costs and health outcomes were discounted based on an annual discount rate of 5.0%, following Ministry of Health guidelines. The health economic evaluation includes direct medical costs from the perspective of the Brazilian public health system, such as: drug acquisition, health state specific disease management costs, terminal care and adverse effects.
RESULTS: Over a lifetime horizon, pembrolizumab monotherapy demonstrated an incremental gain of 0.772 QALYs compared to cetuximab plus chemotherapy in the combined positive score (CPS) ≥ 1 population, with an additional cost of R$ 65,303. The incremental cost-effectiveness ratio (ICER) per QALY was R$ 84,557. Considering the all- comers population, there was an incremental gain of 0.911 QALYs at an additional cost of R$ 78,176 resulting in an ICER per QALY of R$ 85,828 for pembrolizumab combination therapy compared to cetuximab + platinum + 5-FU. These results were lower than the willingness-to-pay threshold of R$ 120.000 three times the gross domestic product (GDP) per capita of Brazil. Results were robust and consistent in sensitivity analyses.
CONCLUSIONS: Pembrolizumab either as monotherapy or in combination with chemotherapy provided grater QALY gains for patients with R/M HNSCC at small additional costs, making it a cost-effective treatment versus cetuximab + platinum + 5-FU in Brazil.
METHODS: A three-state partitioned survival model was developed consisting of two health states of progression-free and progressed disease, and a single state for death (all-causes), using efficacy and safety data from KEYNOTE-048 trial based on final analysis. Utility inputs were derived from the EQ-5D-3L data collected in KEYNOTE-048 using Brazilian algorithm. Costs and health outcomes were discounted based on an annual discount rate of 5.0%, following Ministry of Health guidelines. The health economic evaluation includes direct medical costs from the perspective of the Brazilian public health system, such as: drug acquisition, health state specific disease management costs, terminal care and adverse effects.
RESULTS: Over a lifetime horizon, pembrolizumab monotherapy demonstrated an incremental gain of 0.772 QALYs compared to cetuximab plus chemotherapy in the combined positive score (CPS) ≥ 1 population, with an additional cost of R$ 65,303. The incremental cost-effectiveness ratio (ICER) per QALY was R$ 84,557. Considering the all- comers population, there was an incremental gain of 0.911 QALYs at an additional cost of R$ 78,176 resulting in an ICER per QALY of R$ 85,828 for pembrolizumab combination therapy compared to cetuximab + platinum + 5-FU. These results were lower than the willingness-to-pay threshold of R$ 120.000 three times the gross domestic product (GDP) per capita of Brazil. Results were robust and consistent in sensitivity analyses.
CONCLUSIONS: Pembrolizumab either as monotherapy or in combination with chemotherapy provided grater QALY gains for patients with R/M HNSCC at small additional costs, making it a cost-effective treatment versus cetuximab + platinum + 5-FU in Brazil.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE181
Topic
Economic Evaluation
Disease
SDC: Oncology