Cost-Effectiveness Analysis of Pembrolizumab for First-Line Treatment in Patients With Persistent, Recurrent, and Metastatic Cervical Cancer in the United States: Results From the Final Analysis of Trial
Swami S1, Hale O2, Thornton I3, Muston D4, Monberg MJ5, Monk BJ6
1MSD (UK) Limited, London, LON, UK, 2Lumanity, London, SFK, UK, 3Lumanity, Sheffield, UK, 4Merck & Co., Inc, Summit, NJ, USA, 5Merck & Co., Inc, Rahway, NJ, USA, 6HonorHealth Research and Innovation Institute, University of Arizona, Creighton University, Phoenix, AZ, USA
OBJECTIVES: Previous model-based studies have demonstrated that pembrolizumab in combination with chemotherapy is a cost-effective treatment for patients with persistent, recurrent, and metastatic cervical cancer (PRMCC) with Combined Positive Score (CPS) ≥ 1 in the United States (US). Recently published modeling results using the interim analysis (22 months follow-up) from the phase III KEYNOTE-826 showed that adding pembrolizumab to standard of care (SoC, chemotherapy) was associated with 1.42 additional quality-adjusted life years (QALY) and $203,460 additional costs, leading to an incremental cost-effectiveness ratio (ICER) of $142,850/QALY. This study expands on this earlier work and investigates the cost-effectiveness using extended follow-up (additional 17 months).
METHODS: The existing three-state model using a state transition structure has been updated with data from final analysis of KEYNOTE-826 trial to investigate the cost-effectiveness of pembrolizumab with SoC versus SoC alone over a lifetime horizon (50 years) from a US payer perspective. All costs have been updated to the current price year (2023) and discounted by 3% per annum. Updating the model with more mature trial data also reduces the uncertainty around the extrapolation of long-term outcomes such as progression-free survival and time to progression.
RESULTS: Using KEYNOTE-826 final analysis data leads to an increase in the incremental life years (undiscounted) and QALYs (discounted, 3% per annum) to 4.70 and 2.26 respectively, further suggesting that pembrolizumab + SoC offers substantial incremental health benefits compared to SoC alone. As time on treatment at the interim assessment was mature, incremental costs have remained consistent, resulting in a new ICER of $94,682/QALY, suggesting pembrolizumab + SoC remains cost-effective at the willingness-to-pay threshold of $150,000/QALY.
CONCLUSIONS: This model-based analysis utilizing more mature data from KEYNOTE-826 strengthens evidence for the cost-effectiveness of pembrolizumab + SoC compared with SoC for treatment of CPS ≥ 1 patients with PRMCC in the US.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Economic Evaluation, Study Approaches
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Decision Modeling & Simulation
Oncology, Reproductive & Sexual Health