OBJECTIVES: This study evaluates the cost-effectiveness of the lenvatinib and pembrolizumab (LP) regimen as a second-line treatment for advanced or recurrent endometrial carcinoma (EC) under the context of Taiwan's National Health Insurance (NHI), as currently, the NHI has not covered LP for this indication, despite its recommendation by the European Society for Medical Oncology. Additionally, the study aims to propose a reimbursement price that addresses efficiency concerns associated with this treatment option.

METHODS: A partitioned survival model with three health states and a 20-year time horizon analyzed a hypothetical advanced EC patient population using KEYNOTE-775 trial efficacy results. A piecewise method was employed to extrapolate the overall and progression-free survival curves. The pricing of LP was based on the NHI fee schedule for other cancers, while the direct medical costs were estimated from NHI claim data. Health state utilities and disutilities related to adverse events were obtained from the literature. The willingness-to-pay (WTP) threshold was set at three times the GDP per capita in 2022 (NT$2,925,582). Quality-adjusted life-years (QALYs) and costs were discounted at 3%. Scenario analyses included a 10% price reduction for LP and an extended time horizon. Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty.

RESULTS: The LP regimen provided an incremental gain of 0.98 QALYs at incremental costs of NT$2,949,305, resulting in an incremental cost-effectiveness ratio of NT$3,009,494, slightly exceeding the WTP and with an acceptable possibility of 48.4%. The scenario analysis considering a 10% price reduction for LP showed a 67% probability of the regimen being cost-effective. Additionally, extending the time horizon to 40 years resulted in a 53% probability of LP being cost-effective.

CONCLUSIONS: Although the LP regimen was not cost-effective at the current price schedule, both the 10% LP price reduction and time horizon extension scenario analyses produced acceptable cost-effectiveness results.