Cost-Effectiveness of Pembrolizumab Monotherapy for First-Line Treatment in Adult Patients with Microsatellite Instability High/Mismatch Repair-Deficient Metastatic Colorectal Cancer from a French Perspective

Author(s)

Aguiar-Ibáñez R1, Cagnan L2, Bensimon L3, Mamane C4, Lebbink E5, Crossan C6, Tougeron D7, De la Fouchardière C8, Amonkar M9
1Merck Canada Inc., Toronto, ON, Canada, 2MSD France, Paris, France, 3MSD France, Puteaux, France, 4MSD France, Puteaux, 92, France, 5Lumanity, Utrecht, Netherlands, 6Lumanity, Sheffield, UK, 7CHU Poitiers, Poitiers, France, 8Centre Leon Benard, Lyon, France, 9Merck & Co., Inc., North Wales, PA, USA

OBJECTIVES: To assess the cost-effectiveness of pembrolizumab vs. standard-of-care (SoC) treatments for first-line treatment in adult patients with microsatellite instability high (MSI-H)/mismatch repair-deficient (dMMR) unresectable or metastatic colorectal (mCRC) cancer in France.

METHODS: A three-state transition model (pre-progression, post-progression and death) was developed and adapted to the French setting in order to estimate health outcomes and costs of MSI-H/dMMR mCRC over a 15-year time horizon. Efficacy, safety and utility data were derived from phase III KEYNOTE-177 (KN-177) study (cut-off February 19th 2020), which compared pembrolizumab to SoC (chemotherapy +/- targeted therapy). Progression-free survival (PFS), time to progression (TTP), post-progression survival (PPS), and time on treatment (ToT) from KN-177 study were extrapolated based on parametric methods. Costs included drug acquisition and administration of first and second-line treatment, transportation, follow-up, adverse events management, surgery and end of life. Costs and outcomes were discounted at 2.5% per year. Incremental cost-effectiveness ratio (ICER) was calculated and robustness of the results were assessed using deterministic and probabilistic sensitivity analyses and scenario analyses.

RESULTS: The estimated ICER of pembrolizumab vs. SoC treatments is €47,333/QALY and €44,385/LY (expected gain: 1.52 QALYs (18.2 months) and 1.62 LY (19.4 months); incremental cost: €71,753). Pembrolizumab had a 90% chance of being the most efficient strategy for a willingness-to-pay of €54,000/QALY. The deterministic sensitivity analysis showed that varying the input parameters within their 95% CI had a limited impact on the ICER (variations of less than 5%). The parameter with the greatest impact on the ICER was the estimated pre-progression utility for pembrolizumab. Scenario analyses having the greatest impact on the ICER used separate PPS curves per treatment arm with second-line treatment distribution from KN-177 (€21 480/QALY).

CONCLUSIONS: Pembrolizumab is cost-effective vs. SoC treatments for first-line treatment of adult patients with MSI-H/dMMR mCRC in France assuming a willingness-to-pay of €54,000/QALY.

Conference/Value in Health Info

2022-11, ISPOR Europe 2022, Vienna, Austria

Value in Health, Volume 25, Issue 12S (December 2022)

Code

EE416

Topic

Clinical Outcomes, Economic Evaluation

Topic Subcategory

Comparative Effectiveness or Efficacy, Cost-comparison, Effectiveness, Utility, Benefit Analysis, Trial-Based Economic Evaluation

Disease

SDC: Gastrointestinal Disorders, SDC: Oncology

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