Yeh Justin, Guddati Achuta Kumar
Medical College of Georgia, Augusta University Augusta, GA 30909, USA.
Division of Hematology/Oncology, Georgia Cancer Center, Augusta University Augusta, GA 30909, USA.
Am J Cancer Res. 2020 Jun 1;10(6):1821-1826. eCollection 2020.
Pembrolizumab and nivolumab are anti-PD-1 immunotherapy agents approved for the treatment of metastatic or recurrent head and neck squamous cell carcinoma (HNSCC) with demonstrated benefit as shown by the CheckMate 141 and KEYNOTE-040 clinical trials. Increasing costs of anticancer drugs in particular may influence the choice of treatment. There are limited data and mixed results on the cost-effectiveness of these immunotherapy agents when used in the setting of recurrent or metastatic HNSCC. This study compares the cost-effectiveness of pembrolizumab and nivolumab in this setting. Data published from the CheckMate 141 and KEYNOTE-040 studies were used to generate a model estimating treatment costs and overall survival benefit. Cost of treatment of toxicity-related events were obtained from previous literature and incorporated into calculated costs. Data from both experimental arms and both standard of care arms in the two studies were used for cost estimation in the model. An adjusted standard of care arm was derived from existing data as a common comparator for nivolumab and pembrolizumab. The initial incremental cost-effectiveness ratio (ICER) for nivolumab was $409,000 per quality-adjusted life year (QALY). The initial ICER for pembrolizumab was $1,137,595/QALY. Comparison to adjusted standard of care arm resulted in ICERs of $484,000/QALY and $856,173/QALY, for nivolumab and pembrolizumab, respectively. Nivolumab appears to have a lower cost per QALY and may be more cost-effective than pembrolizumab. Neither drug would be considered a cost-effective treatment option at a threshold of $100,000/QALY for patients in this setting. Outcomes of improved long-term survival have yet to be reported as these agents are relatively new; incorporation of this future data would likely improve the cost-effectiveness of these drugs.
帕博利珠单抗和纳武利尤单抗是获批用于治疗转移性或复发性头颈部鳞状细胞癌（HNSCC）的抗程序性死亡受体1（PD-1）免疫治疗药物，CheckMate 141和KEYNOTE-040临床试验已证明其具有疗效。特别是抗癌药物成本的不断增加可能会影响治疗选择。在复发性或转移性HNSCC的治疗中使用这些免疫治疗药物时，关于其成本效益的数据有限且结果不一。本研究比较了帕博利珠单抗和纳武利尤单抗在这种情况下的成本效益。利用CheckMate 141和KEYNOTE-040研究发表的数据建立一个模型，以估算治疗成本和总体生存获益。毒性相关事件的治疗成本来自以往文献，并纳入计算成本中。两项研究中实验治疗组和标准治疗组的数据均用于模型中的成本估算。从现有数据得出一个调整后的标准治疗组，作为纳武利尤单抗和帕博利珠单抗的共同对照。纳武利尤单抗的初始增量成本效益比（ICER）为每质量调整生命年（QALY）409,000美元。帕博利珠单抗的初始ICER为每QALY 1,137,595美元。与调整后的标准治疗组相比，纳武利尤单抗和帕博利珠单抗的ICER分别为每QALY 484,000美元和每QALY 856,173美元。纳武利尤单抗似乎每QALY成本更低，可能比帕博利珠单抗更具成本效益。在这种情况下，对于患者而言，以每QALY 100,000美元为阈值，这两种药物都不会被视为具有成本效益的治疗选择。由于这些药物相对较新，尚未报告长期生存改善的结果；纳入这些未来数据可能会提高这些药物的成本效益。
