Cost-Effectiveness of Pembrolizumab as Treatment for FIGO 2014 Stage III-IVA Cervical Cancer in the United States
Author(s)
Sarah Brand-Wiita, MSc1, Chien-Jhih Tsai, MS2, Yu-Heng Liu, MSc, PharmD3, Izzy Thornton, MSc2, Elizabeth Beaulieu, MA, PhD4, Dominic Muston, BSc, MSc5, Elizabeth Szamreta, PhD, MPH5, Karin Yamada, MD5, Linda Duska, MD6, Domenica Lorusso, MD7;
1Lumanity, Bethesda, MD, USA, 2Lumanity, London, United Kingdom, 3Lumanity, Sheffield, United Kingdom, 4Merck & Co. Inc, Boston, MA, USA, 5Merck & Co., Inc., Rahway, NJ, USA, 6University of Virginia School of Medicine, Charlottesville, VA, USA, 7Gynaecology Oncology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
1Lumanity, Bethesda, MD, USA, 2Lumanity, London, United Kingdom, 3Lumanity, Sheffield, United Kingdom, 4Merck & Co. Inc, Boston, MA, USA, 5Merck & Co., Inc., Rahway, NJ, USA, 6University of Virginia School of Medicine, Charlottesville, VA, USA, 7Gynaecology Oncology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS and Catholic University of Sacred Heart, Rome, Italy
OBJECTIVES: The FDA recently approved pembrolizumab in combination with chemoradiotherapy (CRT) for treating patients with FIGO 2014 Stage III-IVA cervical cancer (CC). This study evaluates the cost-effectiveness of pembrolizumab plus CRT versus CRT alone in this patient population from a US payer perspective.
METHODS: A state-transition cohort model with time-dependent transition probabilities was developed, composed of four mutually exclusive health states: progression-free, first progression, second progression, and death. Transition probabilities from the progression-free health state were based on parametric survival analyses of patient-level data (PLD) from the ongoing Phase 3 trial KEYNOTE-A18 (pembrolizumab in locally advanced CC, FIGO 2014 Stage III-IVA subgroup). Because few events after first progression have been observed in KEYNOTE-A18, transition probabilities from the post-progression health states were based on analyses of the Phase 3 trial KEYNOTE-826 (pembrolizumab in recurrent or metastatic [R/M] CC). Transition probabilities derived from KEYNOTE-826 were weighted by assumed pembrolizumab utilization in R/M CC (5% after pembrolizumab plus CRT, 95% after CRT alone). Adverse event rates and utility values were based on KEYNOTE-A18. Costs were derived from Analysource (drug acquisition), national statistics (drug administration, other costs), and published literature (end of life costs). Outcomes and costs were discounted at 3% annually over a lifetime horizon. Parameter and structural uncertainty were assessed through deterministic and probabilistic sensitivity analyses.
RESULTS: Patients receiving pembrolizumab plus CRT for this indication are projected to gain an average of 2.15 life years and 1.99 quality-adjusted life years (QALYs) and incur mean incremental costs of $141,884 compared to CRT alone, yielding an incremental cost-effectiveness ratio of $71,452/QALY. In probabilistic analyses, pembrolizumab plus CRT has a 90% chance of being cost-effective at a willingness-to-pay threshold of $150,000/QALY.
CONCLUSIONS: Pembrolizumab plus CRT is projected to be a cost-effective treatment option for patients with FIGO 2014 Stage III-IVA cervical cancer in the US.
METHODS: A state-transition cohort model with time-dependent transition probabilities was developed, composed of four mutually exclusive health states: progression-free, first progression, second progression, and death. Transition probabilities from the progression-free health state were based on parametric survival analyses of patient-level data (PLD) from the ongoing Phase 3 trial KEYNOTE-A18 (pembrolizumab in locally advanced CC, FIGO 2014 Stage III-IVA subgroup). Because few events after first progression have been observed in KEYNOTE-A18, transition probabilities from the post-progression health states were based on analyses of the Phase 3 trial KEYNOTE-826 (pembrolizumab in recurrent or metastatic [R/M] CC). Transition probabilities derived from KEYNOTE-826 were weighted by assumed pembrolizumab utilization in R/M CC (5% after pembrolizumab plus CRT, 95% after CRT alone). Adverse event rates and utility values were based on KEYNOTE-A18. Costs were derived from Analysource (drug acquisition), national statistics (drug administration, other costs), and published literature (end of life costs). Outcomes and costs were discounted at 3% annually over a lifetime horizon. Parameter and structural uncertainty were assessed through deterministic and probabilistic sensitivity analyses.
RESULTS: Patients receiving pembrolizumab plus CRT for this indication are projected to gain an average of 2.15 life years and 1.99 quality-adjusted life years (QALYs) and incur mean incremental costs of $141,884 compared to CRT alone, yielding an incremental cost-effectiveness ratio of $71,452/QALY. In probabilistic analyses, pembrolizumab plus CRT has a 90% chance of being cost-effective at a willingness-to-pay threshold of $150,000/QALY.
CONCLUSIONS: Pembrolizumab plus CRT is projected to be a cost-effective treatment option for patients with FIGO 2014 Stage III-IVA cervical cancer in the US.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE449
Topic
Economic Evaluation
Disease
SDC: Oncology