Cost-Effectiveness of Pembrolizumab in Combination with Chemotherapy in the 1ST LINE Treatment of Metastatic NSCLC in Taiwan
Author(s)
Insinga R1, Arunachalam A2, Lei S3, Shao YJ3, Tan SC4, Spiteri C5
1Merck & Co., Inc., West Point, PA, USA, 2Merck & Co., Inc., North Wales, PA, USA, 3Merck Sharp & Dohme LLC Taiwan Branch, Taipei, Taiwan, 4Merck Sharp & Dohme International GmbH, Singapore, Singapore, 5MSD, Macquarie Park, NSW, Australia
OBJECTIVES : To describe the cost-effectiveness of pembrolizumab plus chemotherapy in non-squamous (NSQ) or squamous (SQ) metastatic NSCLC patients, regardless of PD-L1 expression, in Taiwan. METHODS : Two models were developed utilizing a partitioned survival approach to estimate cost-effectiveness based on interim analyses from the KEYNOTE-189 trial (pembrolizumab + carboplatin/cisplatin + pemetrexed versus chemotherapy alone in NSQ) and KEYNOTE-407 trial (pembrolizumab + carboplatin + paclitaxel versus chemotherapy alone in SQ). Clinical efficacy, treatment utilization, health utility and safety data were derived from the trials and projected over 20 years. For extrapolating survival beyond the trial, a novel Surveillance Epidemiology and End Results (SEER) program population-data approach was applied. Cost-effectiveness is evaluated versus Taiwanese standard of care chemotherapy comparators (for NSQ: platinum + pemetrexed/docetaxel/gemcitabine/paclitaxel; for SQ: carboplatin + paclitaxel/nab-paclitaxel) utilizing results from a network meta-analysis. Resource use and unit costs were from an NHIA perspective. A 3% discount rate is applied to costs and outcomes in reporting ICERs. RESULTS : In the NSQ patients, comparing with all Taiwanese standard of care chemotherapies, pembrolizumab + chemotherapy is projected to increase life expectancy by almost 2 years and the resultant incremental cost/QALY is less than 2 times Taiwan per capita GDP. Similarly, in the comparison against chemotherapy for SQ patients, the same resultant incremental cost/QALY less than 2 times Taiwan per capita GDP for pembrolizumab + chemotherapy regimen. CONCLUSIONS : The addition of pembrolizumab to chemotherapy is projected to extend life expectancy to a point not previously seen in previously untreated metastatic NSCLC. The results suggest pembrolizumab + chemotherapy yields ICERs below a 3 times Taiwan per capita GDP ICER threshold of NTD 2,309,934 /QALY and is cost-effective compared to standard of care chemotherapy for first-line treatment for metastatic NSCLC.
Code
PCN41