OBJECTIVES: COST-EFFECTIVENESS ANALYSIS OF PEMBROLIZUMAB VERSUS NIVOLUMAB AS THE FIRST-LINE TREATMENT FOR ADVANCED AND METASTATIC NON-SMALL CELL LUNG CANCER IN FRANCE

METHODS: To evaluate the cost-effectiveness of pembrolizumab in comparison to nivolumab in the treatment of patients with advanced and metastatic non-small cell lung cancer (NSCLC) as first line treatment strategy in France

RESULTS: A three state partitioned survival model was developed based on the data collected from the clinical trials (Keynote -024, and Checkmate-026) and projected over 20 years. Three disease states used were: progressive disease, progression free survival and death. A rapid review was conducted to collect the cost and utility data for the relevant population. Costs related to drug acquisition, treatment administration, adverse event management, and clinical management of advanced melanoma were included in the model. Drug acquisition costs were based on French prices. Costs and outcomes were discounted at 3% per year. Total costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were computed as primary indicators. One-way and probabilistic sensitivity analyses (PSA) were also performed to assess the robustness of the results.

CONCLUSIONS: In the base case model, pembrolizumab resulted in an incremental cost of €5582, QALY of 0.04, and Life years gain of 0.06 in comparison to nivolumab. The resultant ICER of pembrolizumab vs. nivolumab was €144,357/QALY (€98,707/LY). Probability sensitivity analysis showed that pembrolizumab exhibited no significant advantage over nivolumab to be cost-effective at a WTP threshold of €120,000/QALY in the context of the French health care system. Health state utilities and AE costs strongly influenced cost-effectiveness outcome.