Cost-Effectiveness of Perioperative Pembrolizumab for Early Stage Non-Small Cell Lung Cancer (NSCLC) in Greece
Author(s)
ARISTEIDIS DRAGANIGOS, PharmD, MSc1, Pragya Rai, PhD2, Haidong Feng, MPH, MS3, ANASTASIOS SKROUMPELOS, PhD1, Eleni Iliopoulou, PhD1, Antonis Karokis, MSc1.
1MSD Greece, Athens, Greece, 2Merck & Co., Inc., New Brunswick, NJ, USA, 3Merck, Boston, MA, USA.
1MSD Greece, Athens, Greece, 2Merck & Co., Inc., New Brunswick, NJ, USA, 3Merck, Boston, MA, USA.
OBJECTIVES: Even with surgical resection and systemic adjuvant therapy, the survival rates for early-stage NSCLC remain poor. Perioperative pembrolizumab (4 cycles of neoadjuvant pembrolizumab plus platinum-containing chemotherapy followed by resection and maximum 13 cycles of adjuvant pembrolizumab) is approved for patients with resectable NSCLC at increased risk of recurrence based on the results of KEYNOTE-671, where it demonstrated significant benefit in terms of Overall survival and Event-Free survival vs neo-adjuvant chemotherapy (naCT). This study examined the cost-effectiveness of perioperative pembrolizumab as a treatment for resectable NSCLC compared to naCT in Greece.
METHODS: A cost-effectiveness model was constructed utilizing a Markov cohort framework, that consisted of four mutually exclusive health-states (event-free, locoregional recurrence, distant metastases and death). The model was developed from the perspective of Greek payer, over a lifetime horizon. Efficacy and safety data came from the KEYNOTE-671 trial, relevant metastatic NSCLC clinical trials, and real-world data (e.g., Flatiron Health). Drug acquisition and healthcare resource utilization data were sourced from literature and official sources in the public domain. A 3% annual discount was applied to costs and outcomes. Model uncertainty and robustness were assessed via one-way (OWSA) and probabilistic sensitivity analyses (PSA).
RESULTS: Total life-years (LYs) and Quality adjusted life years (QALYs) were estimated at 8.17 and 6.72 for perioperative pembrolizumab versus 5.61 and 4.58 for naCT, respectively. The Incremental cost-effectiveness ratio (ICER) was calculated as €11,021 per QALY for perioperative pembrolizumab vs. naCT, which is significantly below the Greek willingness-to-pay (WTP) threshold of €64,926 (3x GDP per capita). The PSA indicated the robustness of the base case result, with perioperative pembrolizumab yielding a 100% probability of being cost-effective.
CONCLUSIONS: From the Greek Payer perspective, the current analysis indicates that perioperative pembrolizumab represents a cost-effective treatment option for patients with early-stage NSCLC compared to neo-adjuvant chemotherapy.
METHODS: A cost-effectiveness model was constructed utilizing a Markov cohort framework, that consisted of four mutually exclusive health-states (event-free, locoregional recurrence, distant metastases and death). The model was developed from the perspective of Greek payer, over a lifetime horizon. Efficacy and safety data came from the KEYNOTE-671 trial, relevant metastatic NSCLC clinical trials, and real-world data (e.g., Flatiron Health). Drug acquisition and healthcare resource utilization data were sourced from literature and official sources in the public domain. A 3% annual discount was applied to costs and outcomes. Model uncertainty and robustness were assessed via one-way (OWSA) and probabilistic sensitivity analyses (PSA).
RESULTS: Total life-years (LYs) and Quality adjusted life years (QALYs) were estimated at 8.17 and 6.72 for perioperative pembrolizumab versus 5.61 and 4.58 for naCT, respectively. The Incremental cost-effectiveness ratio (ICER) was calculated as €11,021 per QALY for perioperative pembrolizumab vs. naCT, which is significantly below the Greek willingness-to-pay (WTP) threshold of €64,926 (3x GDP per capita). The PSA indicated the robustness of the base case result, with perioperative pembrolizumab yielding a 100% probability of being cost-effective.
CONCLUSIONS: From the Greek Payer perspective, the current analysis indicates that perioperative pembrolizumab represents a cost-effective treatment option for patients with early-stage NSCLC compared to neo-adjuvant chemotherapy.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE266
Topic
Clinical Outcomes, Economic Evaluation
Disease
Oncology