COST-EFFECTIVENESS OF PEMBROLIZUMAB PLUS CHEMORADIOTHERAPY VERSUS CHEMORADIOTHERAPY ALONE FOR CERVICAL CANCER IN INDIA: A MARKOV MODEL EVALUATION
Author(s)
Shruthi Ashok Kumar, PharmD1, Norah Elsa Shynu, Pharm D2, Arathi Viswam, PharmD3, Anna Ankita, PharmD3, Adusumilli Pramod Kumar, PhD3.
1Student, M S Ramaiah University Of Applied Sciences, Bengaluru, India, 2M S Ramaiah University Of Applied Sciences, Bengaluru, India, 3M S Ramaiah University Of Applied Sciences, Bangalore, India.
1Student, M S Ramaiah University Of Applied Sciences, Bengaluru, India, 2M S Ramaiah University Of Applied Sciences, Bengaluru, India, 3M S Ramaiah University Of Applied Sciences, Bangalore, India.
OBJECTIVES: This study aimed to evaluate the cost-effectiveness of pembrolizumab plus chemoradiotherapy (CRT) compared with CRT alone for the treatment of cervical cancer in India. Lifetime costs and quality-adjusted life years (QALYs) associated with each treatment strategy were estimated using a Markov model. The robustness of the findings was assessed through sensitivity analyses from the Indian healthcare system perspective.
METHODS: A cohort-based Markov model was developed to simulate disease progression in patients with cervical cancer over a 20-year time horizon using monthly cycles. Health states included progression-free survival, disease progression, and death. Transition probabilities were derived from published clinical trial data, while costs and utility values were obtained from the literature and adapted to the Indian healthcare setting. Costs were discounted at an annual rate of 3% and reported in Indian Rupees (INR) with Euro (€) equivalents for international comparability. Outcomes included total costs, QALYs, and the incremental cost-effectiveness ratio (ICER). Deterministic and sensitivity analyses were conducted to evaluate model uncertainty.
RESULTS: Pembrolizumab plus CRT generated 3.35 QALYs at a total cost of INR 91,10,668 (€97,900), whereas CRT alone generated 2.08 QALYs at a total cost of INR 2,95,099 (€3,200). Compared with CRT alone, pembrolizumab plus CRT resulted in an incremental gain of 1.27 QALYs and an incremental cost of INR 88,15,569 (€94,700). The resulting ICER was INR 69,16,487 (€74,400) per QALY gained. Sensitivity analyses showed that results were most influenced by pembrolizumab acquisition costs and utility estimates; however, the base-case findings remained robust across plausible parameter ranges.
CONCLUSIONS: Pembrolizumab plus CRT was associated with improved health outcomes compared with CRT alone but incurred substantially higher treatment costs. At a willingness-to-pay threshold of INR 1,50,000 (€1,600) per QALY, pembrolizumab plus CRT is unlikely to be considered cost-effective in the Indian healthcare setting.
METHODS: A cohort-based Markov model was developed to simulate disease progression in patients with cervical cancer over a 20-year time horizon using monthly cycles. Health states included progression-free survival, disease progression, and death. Transition probabilities were derived from published clinical trial data, while costs and utility values were obtained from the literature and adapted to the Indian healthcare setting. Costs were discounted at an annual rate of 3% and reported in Indian Rupees (INR) with Euro (€) equivalents for international comparability. Outcomes included total costs, QALYs, and the incremental cost-effectiveness ratio (ICER). Deterministic and sensitivity analyses were conducted to evaluate model uncertainty.
RESULTS: Pembrolizumab plus CRT generated 3.35 QALYs at a total cost of INR 91,10,668 (€97,900), whereas CRT alone generated 2.08 QALYs at a total cost of INR 2,95,099 (€3,200). Compared with CRT alone, pembrolizumab plus CRT resulted in an incremental gain of 1.27 QALYs and an incremental cost of INR 88,15,569 (€94,700). The resulting ICER was INR 69,16,487 (€74,400) per QALY gained. Sensitivity analyses showed that results were most influenced by pembrolizumab acquisition costs and utility estimates; however, the base-case findings remained robust across plausible parameter ranges.
CONCLUSIONS: Pembrolizumab plus CRT was associated with improved health outcomes compared with CRT alone but incurred substantially higher treatment costs. At a willingness-to-pay threshold of INR 1,50,000 (€1,600) per QALY, pembrolizumab plus CRT is unlikely to be considered cost-effective in the Indian healthcare setting.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE399
Topic
Economic Evaluation, Health Technology Assessment, Patient-Centered Research
Disease
Oncology, Urinary/Kidney Disorders