COST-EFFECTIVENESS OF NEOADJUVANT AND ADJUVANT PEMBROLIZUMAB IN LOCALLY ADVANCED HEAD AND NECK CANCER
Author(s)
Jonathan N. Luong, PharmD1, David Veenstra, PharmD, PhD2;
1University of Washington, Student, Seattle, WA, USA, 2CHOICE Institute, University of Washington, Seattle, WA, USA
1University of Washington, Student, Seattle, WA, USA, 2CHOICE Institute, University of Washington, Seattle, WA, USA
OBJECTIVES: This preliminary analysis aims to estimate the cost-effectiveness of neoadjuvant and adjuvant pembrolizumab when added to cisplatin and radiotherapy in PD-L1 positive locally advanced head and neck cancer from a US payer perspective based on findings from the KEYNOTE-689 clinical trial.
METHODS: We implemented a 3-state partitioned-survival model (event-free survival, progressed disease, and death) to assess the difference in QALYs and costs between pembrolizumab with standard of care and standard of care alone over a 25-year timeframe. We selected curve fits based on lowest Akaike information criterion (AIC) value, visual inspection, and clinical plausibility. Costs were sourced from CMS and Redbook, and health state utilities and utility decrements were sourced from the literature. A discount rate of 3% per year was applied to costs and health outcomes. The ICER was calculated and reported as USD per QALY gained. A scenario analysis was evaluated in which curves with a cure fraction were selected. Uncertainty was evaluated in one-way and probabilistic sensitivity analyses, with key costs, utility values, and curve parameters varied.
RESULTS: In the base case, pembrolizumab in combination with standard of care yielded an additional 1.64 QALYs at an incremental cost of $361,600 in comparison to stand of care alone, resulting in an ICER of $220,800. The scenario analysis yielded in an ICER of $212,800. Our one-way sensitivity analysis found curve parameters to have the greatest influence on the base case results, and the probabilistic sensitivity analysis found that pembrolizumab had 35.4% likelihood of being cost-effective at a $150,000/QALY threshold.
CONCLUSIONS: Our preliminary analysis suggests pembrolizumab may not be cost-effective in addition to current standard of care for PD-L1 positive locally advanced head and neck cancer from a US payer perspective. Future analyses should incorporate more mature survival data as it becomes available as well as trial-specific health-related quality of life findings.
METHODS: We implemented a 3-state partitioned-survival model (event-free survival, progressed disease, and death) to assess the difference in QALYs and costs between pembrolizumab with standard of care and standard of care alone over a 25-year timeframe. We selected curve fits based on lowest Akaike information criterion (AIC) value, visual inspection, and clinical plausibility. Costs were sourced from CMS and Redbook, and health state utilities and utility decrements were sourced from the literature. A discount rate of 3% per year was applied to costs and health outcomes. The ICER was calculated and reported as USD per QALY gained. A scenario analysis was evaluated in which curves with a cure fraction were selected. Uncertainty was evaluated in one-way and probabilistic sensitivity analyses, with key costs, utility values, and curve parameters varied.
RESULTS: In the base case, pembrolizumab in combination with standard of care yielded an additional 1.64 QALYs at an incremental cost of $361,600 in comparison to stand of care alone, resulting in an ICER of $220,800. The scenario analysis yielded in an ICER of $212,800. Our one-way sensitivity analysis found curve parameters to have the greatest influence on the base case results, and the probabilistic sensitivity analysis found that pembrolizumab had 35.4% likelihood of being cost-effective at a $150,000/QALY threshold.
CONCLUSIONS: Our preliminary analysis suggests pembrolizumab may not be cost-effective in addition to current standard of care for PD-L1 positive locally advanced head and neck cancer from a US payer perspective. Future analyses should incorporate more mature survival data as it becomes available as well as trial-specific health-related quality of life findings.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE148
Topic
Economic Evaluation
Disease
SDC: Oncology