PROJECTED HEALTH OUTCOMES AND RESOURCE USE: IMPACT OF INTRODUCING PEMBROLIZUMAB (INCLUDING INTRAVENOUS AND SUBCUTANEOUS ADMINISTRATION) IN EARLY-STAGE HEAD AND NECK SQUAMOUS CELL CARCINOMA (HNSCC) IN THE U.S. MEDICARE POPULATION
Author(s)
Feng (Johnson) Qian, MBA, MS, PhD, MD1, Sam Greenall, MSc2, Colin Burke, MSc3, Catarina Neves, MSc4, Yizhen Lai, MSc5.
1Associate Director, Merck, Rahway, NJ, NY, USA, 2Lumanity, Manchester, United Kingdom, 3Lumanity, London,, United Kingdom, 4Lumanity, Utrecht, Netherlands, 5Merck & Co., Inc, Boston, MA, USA.
1Associate Director, Merck, Rahway, NJ, NY, USA, 2Lumanity, Manchester, United Kingdom, 3Lumanity, London,, United Kingdom, 4Lumanity, Utrecht, Netherlands, 5Merck & Co., Inc, Boston, MA, USA.
OBJECTIVES: To quantify the impact on the U.S. Medicare population in terms of (1) health outcomes after introducing perioperative pembrolizumab for resectable locally advanced (LA) head and neck squamous cell carcinoma (HNSCC) and (2) administration time-related outcomes after adopting subcutaneous (SC) versus intravenous (IV) pembrolizumab.
METHODS: A population-based model was developed for pembrolizumab in resectable LA HNSCC using a four-state Markov structure, comparing two scenarios over 10 years: pembrolizumab available as perioperative treatment versus pembrolizumab reserved for metastatic disease. Health outcomes included life years (LYs; total and event-free [EF]), quality-adjusted LYs (QALYs), recurrences, active treatments for metastatic disease, and deaths (total and after recurrence). Efficacy was informed by KEYNOTE-689. Administration time-related outcomes were evaluated by comparing an IV-only pembrolizumab scenario with an alternative scenario in which a subset of administrations used pembrolizumab SC. Outcomes included active healthcare practitioner time, treatment room time, chair time, active administration time, and number of IV infusion visits, based on a published time-and-motion study. All outcomes were discounted at 3% annually.
RESULTS: Over 10 years, treating 31,602 of 57,945 eligible U.S. Medicare patients with perioperative pembrolizumab, versus reserving it for metastatic disease, was projected to increase total and EF LYs by 9,835 (+6%) and 13,836 (+10%), and QALYs by 8,313 (+7%); avoid 2,841 (-15%) recurrences and 3,128 (-19%) active metastatic treatments; prevent 2,732 (-10%) and 3,087 (-21%) deaths in total and after recurrence. In a conservative scenario in which pembrolizumab SC was used instead of IV in 11,464 patients, the largest reductions were observed in active administration hours (-71,541; -33%) and IV infusion visits (-160,767; -37%).
CONCLUSIONS: The introduction of pembrolizumab for resectable LA HNSCC in the U.S. Medicare population is projected to meaningfully improve health outcomes. SC administration may improve the efficiency of immunotherapy delivery by reducing administration time and IV infusion visits, easing treatment-capacity constraints.
METHODS: A population-based model was developed for pembrolizumab in resectable LA HNSCC using a four-state Markov structure, comparing two scenarios over 10 years: pembrolizumab available as perioperative treatment versus pembrolizumab reserved for metastatic disease. Health outcomes included life years (LYs; total and event-free [EF]), quality-adjusted LYs (QALYs), recurrences, active treatments for metastatic disease, and deaths (total and after recurrence). Efficacy was informed by KEYNOTE-689. Administration time-related outcomes were evaluated by comparing an IV-only pembrolizumab scenario with an alternative scenario in which a subset of administrations used pembrolizumab SC. Outcomes included active healthcare practitioner time, treatment room time, chair time, active administration time, and number of IV infusion visits, based on a published time-and-motion study. All outcomes were discounted at 3% annually.
RESULTS: Over 10 years, treating 31,602 of 57,945 eligible U.S. Medicare patients with perioperative pembrolizumab, versus reserving it for metastatic disease, was projected to increase total and EF LYs by 9,835 (+6%) and 13,836 (+10%), and QALYs by 8,313 (+7%); avoid 2,841 (-15%) recurrences and 3,128 (-19%) active metastatic treatments; prevent 2,732 (-10%) and 3,087 (-21%) deaths in total and after recurrence. In a conservative scenario in which pembrolizumab SC was used instead of IV in 11,464 patients, the largest reductions were observed in active administration hours (-71,541; -33%) and IV infusion visits (-160,767; -37%).
CONCLUSIONS: The introduction of pembrolizumab for resectable LA HNSCC in the U.S. Medicare population is projected to meaningfully improve health outcomes. SC administration may improve the efficiency of immunotherapy delivery by reducing administration time and IV infusion visits, easing treatment-capacity constraints.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE378
Topic
Economic Evaluation, Health Technology Assessment
Topic Subcategory
Novel & Social Elements of Value, Trial-Based Economic Evaluation
Disease
Oncology