Cost-Effectiveness of Pembrolizumab Plus Chemotherapy, With or Without Bevacizumab for the First-Line Treatment of PD-L1-Positive Patients With Persistent, Recurrent, or Metastatic Cervical Cancer in France
Ray-Coquard I1, Pautier P2, Muston D3, Monberg MJ4, Swami S5, Chaker O6, Bensimon L7, Lange S8, Kulakova M9, Durand Zaleski I10, Marié L8
1Centre Léon Bérard, and University Claude Bernard Lyon I, Lyon and GINECO, France, Lyon, France, 2Institut Gustave Roussy, VILLEJUIF, France, 3Merck & Co., Inc, Summit, NJ, USA, 4Merck & Co., Inc, Rahway, NJ, USA, 5MSD (UK) Limited, London, LON, UK, 6MSD, Paris, France, 7MSD, Courbevoie, 92, France, 8stève consultants, Paris, France, 9Lumanity, Sheffield, UK, 10ECEVE UMR 1123, CRETEIL, France
OBJECTIVES: To assess the cost-effectiveness of pembrolizumab with chemotherapy (with or without bevacizumab) versus chemotherapy (with or without bevacizumab) in PD-L1-positive (CPS≥1) patients with persistent, recurrent, or metastatic cervical cancer, from the French healthcare perspective.
METHODS: A three-state semi-Markov model (pre-progression, post-progression and death) was adapted to French settings to estimate the cost-effectiveness of pembrolizumab + chemotherapy ± bevacizumab versus chemotherapy ± bevacizumab. Clinical and quality of life data were obtained from patient-level data of the phase 3 study KEYNOTE-826 interim analysis. Progression-free survival, time to progression, post-progression survival and time on treatment were extrapolated over a 7-year time horizon based on piecewise models. EQ-5D-5L data estimated by a regression model were converted to French population-based utilities using the French value set. Only direct medical costs were considered, based on public sources. Costs and health outcomes were discounted at 2.5% per year. Incremental cost-effectiveness ratio (ICER) was calculated as cost per quality-adjusted life year (QALY) gained. Deterministic and probabilistic sensitivity analyses and scenarios analyses were conducted to assess robustness of results.
RESULTS: Pembrolizumab plus chemotherapy ± bevacizumab generates an incremental cost of €111,341 and 2.35 incremental QALYs per patient compared to chemotherapy ± bevacizumab, resulting in an ICER of €168,076/QALY. Results were mostly sensitive to methods of extrapolation and treatment duration, with an ICER varying from €134,644/QALY (-20%), to €197 473/QALY (+17%). A scenario using a partitioned survival model produces an ICER of €193 482/QALY. Exploratory subgroups analyses relative to the use of bevacizumab are associated with ICERs from €158 738/QALY in patients receiving bevacizumab to €214 450 /QALY in patients not receiving bevacizumab. Pembrolizumab plus chemotherapy ± bevacizumab has more than 80% probability of being cost-effective below the willingness-to-pay threshold of €250,000/QALY.
CONCLUSIONS: Combining pembrolizumab with chemotherapy, regardless of the use of bevacizumab, improves life expectancy and appears cost-effective versus chemotherapy.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Cost-comparison, Effectiveness, Utility, Benefit Analysis