KEY TAKEAWAYS
- KEYNOTE-040 is a phase 3 clinical trial investigating pembrolizumab’s efficacy in treating r/mHNSCC.
- This analysis aimed to determine the cost-effectiveness of pembrolizumab versus standard-of-care therapy in r/mHNSCC in China.
- A Markov model was used to compare the costs and effectiveness of pembrolizumab and SOC.
- The analysis showed that pembrolizumab did not meet China’s willingness-to-pay threshold of US$28 130/QALY.
Patients with recurrent or metastatic head and neck squamous cell carcinoma (r/mHNSCC) have recently been shown to benefit from treatment with pembrolizumab in terms of survival. Yet, it still needs to be determined whether or not pembrolizumab is more cost-effective than chemotherapy in China. Pembrolizumab versus standard-of-care (SOC) therapy for r/mHNSCC in China: a cost-effectiveness analysis.
To evaluate the relative value of pembrolizumab and SOC in platinum-resistant r/mHNSCC, a Markov model with three health states (stable, progressing, and dead) was constructed. Health utility estimates were derived through a literature search, whereas transition probability data was acquired from the KEYNOTE-040 experiment. The payer-side cost information was collected in China. The costs and the results were discounted at a rate of 3.0% per year. Sensitivity studies were performed to investigate the potential effects of variations in the model’s input parameters.
Cost per quality-adjusted life year (QALYs) was used as the primary outcome measure, with the incremental cost-effectiveness ratios(ICER) as a secondary measure of importance. Pembrolizumab had a mean price of US$45 861, while SOC averaged US$41 950. Regarding quality-of-life gains, pembrolizumab was more effective than standard-of-care (SOC) treatment (0.25 QALYs vs. 0.31 QALYs). Pembrolizumab’s ICER exceeded China’s willingness-to-pay level (WTP), set at US$28,130/QALY. Utility values for the progressive state, the chance of transition from stable to progressive in the SOC group, and the cost of pembrolizumab were the three most influential variables on incremental cost-effectiveness ratio (ICER) in the univariate sensitivity analysis. With a WTP value of US$28,130/QALY, the probabilistic sensitivity analysis showed that conventional therapy was more likely to be cost-effective than pembrolizumab. Both the univariate analysis and the probabilistic sensitivity analysis yielded consistent findings.
Source: https://pubmed.ncbi.nlm.nih.gov/33371020/
Clinical Trial: https://clinicaltrials.gov/ct2/show/NCT02252042
Xin W, Ding H, Fang Q, Zheng X, Tong Y, Xu G, Yang G. Cost-effectiveness of pembrolizumab for treatment of platinum-resistant recurrent or metastatic head and neck squamous cell carcinoma in China: an economic analysis based on a randomized, open-label, phase III trial. BMJ Open. 2020 Dec 18;10(12):e038867. doi: 10.1136/bmjopen-2020-038867. PMID: 33371020; PMCID: PMC7751211.
