Presentation (CTI)

OBJECTIVES: Taiwan’s National Health Insurance (NHI) currently limits pembrolizumab reimbursement for recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) to patients with a Combined Positive Score (CPS) ≥ 20. This study evaluates the cost-effectiveness of pembrolizumab monotherapy versus the EXTREME regimen and pembrolizumab plus chemotherapy versus the EXTREME regimen across three subgroups (CPS ≥ 20, CPS ≥ 1, and total population) from the payer’s perspective.
METHODS: A partitioned survival model with a 10-year horizon was developed using clinical efficacy from the KEYNOTE-048 trial. Utility values were sourced from published international literature. Costs for drug acquisition, administration, and disease management were sourced from the NHI fee schedule. Outcomes were quality-adjusted life years (QALYs) discounted at 3% annually. The willingness-to-pay (WTP) threshold was set at 3 times Taiwan’s GDP per capita (~US$118,431).
RESULTS: Compared to the EXTREME regimen, pembrolizumab monotherapy improved QALYs, yielding ICERs of US$29,993 (CPS ≥ 20), US$30,432 (CPS ≥ 1), and US$32,309 (total population) per QALY. At the 3 times GDP threshold, the probabilities of cost-effectiveness for monotherapy were 95.2% (CPS ≥ 20), 94.4% (CPS ≥ 1), and 82.0% (total population).Compared to the EXTREME regimen, pembrolizumab plus chemotherapy increased QALYs, yielding ICERs of US$36,322 (CPS ≥ 20), US$42,983 (CPS ≥ 1), and US$43,920 (total population) per QALY. At the 3 times GDP threshold, the probabilities of cost-effectiveness for combination therapy were 92.3% (CPS ≥ 20), 83.5% (CPS ≥ 1), and 81.0% (total population).
CONCLUSIONS: Compared with the EXTREME regimen, pembrolizumab monotherapy and pembrolizumab combination therapy are both cost-effective for patients with R/M HNSCC under the 3 times GDP threshold.