OBJECTIVES:

Non-small-cell lung cancer (NSCLC) accounts for around 85% of all lung cancer types and both pembrolizumab and nivolumab are effective treatment options for the treatment of NSCLC. The objective of this model was to evaluate the cost-effectiveness of pembrolizumab in comparison to nivolumab in the treatment of patients with advanced and metastatic non-small cell lung cancer (NSCLC) as first line treatment strategy in United Kingdom.

METHODS:

A three state partitioned survival model was developed based on the data collected from the clinical trials (Keynote -024, and Checkmate-026) and projected over 20 years. Three disease states used were: progressive disease, progression free survival and death. A rapid review was conducted to collect the cost and utility data for the relevant population. Costs related to drug acquisition, treatment administration, adverse event management, and clinical management of advanced melanoma were included in the model. Drug acquisition costs were based on UK list prices. Costs and outcomes were discounted at 3.5% per year. Total costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) were computed as primary indicators. One-way and probabilistic sensitivity analyses (PSA) showed that the base case results were consistent under variation of various model inputs.

RESULTS:

In the base case model, pembrolizumab resulted in an incremental cost of £7182, QALY of 0.05, and Life years gain of 0.06 in comparison to nivolumab. The resultant ICER of pembrolizumab vs. nivolumab was £154,805/QALY (£125,362/LY). Probability sensitivity analysis showed that pembrolizumab exhibited no significant advantage over nivolumab to be cost-effective at a WTP threshold of £114,000/QALY in the context of the UK health care system. Health state utilities strongly influenced the cost-effectiveness outcome.

CONCLUSIONS:

The results show that pembrolizumab is not a cost-effective treatment compared with nivolumab as a first line treatment of advanced and metastatic non-small cell lung cancer patients in UK healthcare setting.