Exploring the Broader Societal Value of Pembrolizumab in Triple-Negative Breast Cancer and Cervical Cancer in Brazil
Author(s)
Nishini Wijenayake, MSc1, Daniel Ladino, MSc1, Karl Patterson, PhD1, Annabelle Davies, MSc2, Mariana Rosim, PhD3, Monica M. Rojas, MD MPH4, Kate Young, PhD MPH5;
1Lumanity, London, United Kingdom, 2MSD UK, London, United Kingdom, 3MSD Brazil, Sao Paulo, Brazil, 4MSD Columbia, Bogota, Colombia, 5Merck & Co. Inc, Principal Scientist, Rahway, NJ, USA
1Lumanity, London, United Kingdom, 2MSD UK, London, United Kingdom, 3MSD Brazil, Sao Paulo, Brazil, 4MSD Columbia, Bogota, Colombia, 5Merck & Co. Inc, Principal Scientist, Rahway, NJ, USA
OBJECTIVES: Pembrolizumab is an immune checkpoint inhibitor that is approved across jurisdictions for multiple cancer indications. Our study analyzes the traditional payer, traditional societal, and broader societal incremental cost-effectiveness ratios (ICERs) of pembrolizumab-based therapies for early triple-negative breast cancer (TNBC) and persistent, recurrent, or metastatic cervical cancer (CC) in a Brazilian setting. We incorporate novel elements of value described by the third ISPOR Special Task Force Report alongside new elements considered relevant to the disease.
METHODS: Two cost-effectiveness models, previously used in health technology assessments (Brazilian public healthcare perspective) for pembrolizumab versus standard of care in TNBC and CC, were expanded to include elements constituting the traditional societal perspective (productivity) and the broad societal perspective (including caregiver burden, insurance value, value of hope, real option value, severity of disease, out-of-pocket expenses, and fertility treatment costs). A targeted literature review identified inputs for each element. An overall ICER was generated across indications by weighting individual results by prevalence. Probabilistic sensitivity analysis and scenario analyses were implemented to analyze the robustness of results.
RESULTS: The overall broad societal ICER was R$45,180 per quality-adjusted life year (QALY), substantially lower than the traditional payer and traditional societal ICER (R$139,083/QALY and R$141,152/QALY, respectively). This was largely driven by the substantial insurance value impact on QALYs, with the next most influential element being the value of hope. Probabilistic analyses were consistent with deterministic results.
CONCLUSIONS: Our work shows that including broader societal elements of value resulted in a significantly lower ICER than the traditional payer perspective, indicating that traditional payer and societal perspectives often used for HTAs may be missing key elements of value. However, the paucity of disease-specific input data and the highly uncertain estimation of some of the value elements warrants further research to reduce uncertainty around the true broad societal value of pembrolizumab.
METHODS: Two cost-effectiveness models, previously used in health technology assessments (Brazilian public healthcare perspective) for pembrolizumab versus standard of care in TNBC and CC, were expanded to include elements constituting the traditional societal perspective (productivity) and the broad societal perspective (including caregiver burden, insurance value, value of hope, real option value, severity of disease, out-of-pocket expenses, and fertility treatment costs). A targeted literature review identified inputs for each element. An overall ICER was generated across indications by weighting individual results by prevalence. Probabilistic sensitivity analysis and scenario analyses were implemented to analyze the robustness of results.
RESULTS: The overall broad societal ICER was R$45,180 per quality-adjusted life year (QALY), substantially lower than the traditional payer and traditional societal ICER (R$139,083/QALY and R$141,152/QALY, respectively). This was largely driven by the substantial insurance value impact on QALYs, with the next most influential element being the value of hope. Probabilistic analyses were consistent with deterministic results.
CONCLUSIONS: Our work shows that including broader societal elements of value resulted in a significantly lower ICER than the traditional payer perspective, indicating that traditional payer and societal perspectives often used for HTAs may be missing key elements of value. However, the paucity of disease-specific input data and the highly uncertain estimation of some of the value elements warrants further research to reduce uncertainty around the true broad societal value of pembrolizumab.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE266
Topic
Economic Evaluation
Topic Subcategory
Novel & Social Elements of Value, Trial-Based Economic Evaluation, Work & Home Productivity - Indirect Costs
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology