The Health Impact of Pembrolizumab for the First-Line Treatment for Metastatic Non-Small Cell Lung Cancer (mNSCLC) That Expresses High Levels of PD-L1 in Türkiye
Author(s)
Burcu Akyol Ersoy, BSc, MBA1, Yasemin Ceylan, BSc1, Ugur Akpamuk, BSc1, Gozde Ozcan, MSc1, Yasemin Esen, MD1, Mert Batum, MD1, Berfin Torun, MD1, Bernadette Poellinger, PhD2, Carole Mamane, BSc, MSc3, Ralph Insinga, PhD4, Sylvi Nguyen, MSc5, Simten Malhan, Prof6, Irfan Cicin, Prof7.
1Merck Sharp & Dohme Ltd. (Turkey), Istanbul, Turkey, 2MSD Sharp & Dohme GmbH, München, Germany, 3MSD France, Puteaux, 92800, France, 4Merck & Co. Inc, West Point, PA, USA, 5MSD, Oslo, Norway, 6Department of Healthcare Management, Baskent University, Ankara, Turkey, 7Department of Medical Oncology, Istinye University, Faculty of Medicine, Istanbul, Turkey.
1Merck Sharp & Dohme Ltd. (Turkey), Istanbul, Turkey, 2MSD Sharp & Dohme GmbH, München, Germany, 3MSD France, Puteaux, 92800, France, 4Merck & Co. Inc, West Point, PA, USA, 5MSD, Oslo, Norway, 6Department of Healthcare Management, Baskent University, Ankara, Turkey, 7Department of Medical Oncology, Istinye University, Faculty of Medicine, Istanbul, Turkey.
OBJECTIVES: Lung cancer (LC) is the leading cause of cancer-related mortality worldwide, accounting for nearly 20% of all cancer deaths. In Türkiye, LC was the most common and deadliest cancer, with 41,032 new cases diagnosed and 38,505 related deaths in 2022. This analysis aims to evaluate the health impact of a PD-L1 biomarker directed treatment strategy of pembrolizumab in previously untreated mNSCLC with PD-L1 expression in ≥50% of tumor cells and no sensitizing epidermal growth factor receptor mutation or anaplastic lymphoma kinase translocation.
METHODS: A partitioned survival model was adapted to the Turkish payer perspective to compare the health impact in terms of life years (LYs) and quality-adjusted life years (QALYs) of pembrolizumab with standard platinum-based chemotherapy over a 20-year time horizon. Data on clinical efficacy outcomes, treatment utilization, health utilities, and safety were derived from 5-year follow-up KEYNOTE-024 trial data, with a June 2020 cut-off date. A 3% annual discount rate was applied to health outcomes. To assess the robustness of the model results, scenario analyses, deterministic sensitivity analyses and probabilistic sensitivity analyses were conducted.
RESULTS: The model estimated total QALYs of 3.45 for pembrolizumab vs 1.96 for chemotherapy. Total LYs were estimated to be 4.12 and 2.45 for pembrolizumab and chemotherapy, respectively. The use of pembrolizumab was associated with an increase of 1.49 QALYs vs 1.67 LYs. Results from the scenario and sensitivity analyses supported the base-case findings. The most impactful parameters on the results were the parametric extrapolation of OS and utility values for the time to death ≥ 360 days health state, for both arms.
CONCLUSIONS: The results indicate that pembrolizumab as a first-line treatment for mNSCLC with high PD-L1 expression in Türkiye yields an incremental gain in QALYs and LYs. Therefore, pembrolizumab should be considered for public reimbursement in Türkiye.
METHODS: A partitioned survival model was adapted to the Turkish payer perspective to compare the health impact in terms of life years (LYs) and quality-adjusted life years (QALYs) of pembrolizumab with standard platinum-based chemotherapy over a 20-year time horizon. Data on clinical efficacy outcomes, treatment utilization, health utilities, and safety were derived from 5-year follow-up KEYNOTE-024 trial data, with a June 2020 cut-off date. A 3% annual discount rate was applied to health outcomes. To assess the robustness of the model results, scenario analyses, deterministic sensitivity analyses and probabilistic sensitivity analyses were conducted.
RESULTS: The model estimated total QALYs of 3.45 for pembrolizumab vs 1.96 for chemotherapy. Total LYs were estimated to be 4.12 and 2.45 for pembrolizumab and chemotherapy, respectively. The use of pembrolizumab was associated with an increase of 1.49 QALYs vs 1.67 LYs. Results from the scenario and sensitivity analyses supported the base-case findings. The most impactful parameters on the results were the parametric extrapolation of OS and utility values for the time to death ≥ 360 days health state, for both arms.
CONCLUSIONS: The results indicate that pembrolizumab as a first-line treatment for mNSCLC with high PD-L1 expression in Türkiye yields an incremental gain in QALYs and LYs. Therefore, pembrolizumab should be considered for public reimbursement in Türkiye.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH237
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
Oncology