COST-EFFECTIVENESS OF PEMBROLIZUMAB AS FIRST-LINE TREATMENT FOR METASTATIC NON-SMALL CELL LUNG CANCER WITH HIGH PD-L1 EXPRESSION IN SAUDI ARABIA
Author(s)
Bandar S. Alghamdi, Sr., B.pharm1, Ziyad ALMALKI, PhD2.
1Prince sattam bin abdulaziz university, Riyadh, Saudi Arabia, 2VIP Platinum, Riyadh, Saudi Arabia.
1Prince sattam bin abdulaziz university, Riyadh, Saudi Arabia, 2VIP Platinum, Riyadh, Saudi Arabia.
OBJECTIVES: Pembrolizumab monotherapy is approved as a first-line treatment for metastatic non-small cell lung cancer (NSCLC) with a PD-L1 tumor proportion score (TPS) ≥ 50%, based on the KEYNOTE-024 trial. This study aimed to evaluate the cost-effectiveness of pembrolizumab compared with standard platinum-based chemotherapy in this patient population from the perspective of the Saudi Ministry of Health. Additionally, the study assessed the impact of treatment costs, adverse events, and PD-L1 testing on overall cost-effectiveness outcomes.
METHODS: We adapted a partitioned-survival model to estimate progression-free survival, overall survival, treatment costs, costs of adverse events and disease management, and health utilities over a 30-year time horizon. Clinical and resource utilization inputs were derived from the KEYNOTE-024 trial and expert opinion from local oncologists. An annual discount rate of 3% was applied. Sensitivity analyses and scenario analyses were conducted to address uncertainty.
RESULTS: Pembrolizumab monotherapy was estimated to provide an additional 0.89 quality-adjusted life years compared to standard of care in the first-line setting for patients with NSCLC and a TPS ≥ 50%. However, the projected incremental cost for pembrolizumab was $128,811, resulting in an incremental cost-effectiveness ratio of $96,874 per QALY gained. A scenario analysis considering universal PD-L1 testing and pembrolizumab treatment for eligible patients yielded an ICER of $110,834. Implementing a pembrolizumab patient access program reduced the ICER to $87,612 per QALY.
CONCLUSIONS: Our findings suggest that pembrolizumab as first-line treatment for NSCLC patients with a TPS ≥ 50% is not cost-effective from the perspective of the Saudi Ministry of Health, the ICER remained above conventional willingness-to-pay thresholds.
METHODS: We adapted a partitioned-survival model to estimate progression-free survival, overall survival, treatment costs, costs of adverse events and disease management, and health utilities over a 30-year time horizon. Clinical and resource utilization inputs were derived from the KEYNOTE-024 trial and expert opinion from local oncologists. An annual discount rate of 3% was applied. Sensitivity analyses and scenario analyses were conducted to address uncertainty.
RESULTS: Pembrolizumab monotherapy was estimated to provide an additional 0.89 quality-adjusted life years compared to standard of care in the first-line setting for patients with NSCLC and a TPS ≥ 50%. However, the projected incremental cost for pembrolizumab was $128,811, resulting in an incremental cost-effectiveness ratio of $96,874 per QALY gained. A scenario analysis considering universal PD-L1 testing and pembrolizumab treatment for eligible patients yielded an ICER of $110,834. Implementing a pembrolizumab patient access program reduced the ICER to $87,612 per QALY.
CONCLUSIONS: Our findings suggest that pembrolizumab as first-line treatment for NSCLC patients with a TPS ≥ 50% is not cost-effective from the perspective of the Saudi Ministry of Health, the ICER remained above conventional willingness-to-pay thresholds.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE519
Topic
Clinical Outcomes, Economic Evaluation, Patient-Centered Research
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Oncology