Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland.
Medical Oncology, Department of Internal Medicine, Cantonal Hospital Lucerne, Lucerne, Switzerland.
Eur J Health Econ. 2021 Jul;22(5):669-677. doi: 10.1007/s10198-021-01282-4. Epub 2021 Mar 21.
Pembrolizumab monotherapy or in combination with chemotherapy are two new treatment options for patients with metastatic non-squamous non-small cell lung cancer (NSCLC) and high (≥ 50%) programmed death ligand 1 (PD-L1) expression. We conducted a cost-effectiveness analysis for Switzerland comparing these two options but also pembrolizumab to chemotherapy.
We constructed a 3-state Markov model with a time horizon of 10 years. Parametric functions were fitted to Kaplan-Meier overall survival (OS) and progression-free survival (PFS) using 2-year follow-up data from the KN-024 and KN-189 registration trials. We included estimated costs for further treatment lines and costs for best supportive care. Costs were assessed from the Swiss healthcare payer perspective. We used published utility values.
Combination therapy resulted in an expected gain of 0.17 quality-adjusted life years (QALYs) per patient and incremental costs of Swiss Francs (CHF) 81,085 as compared to pembrolizumab. These estimates led to an incremental cost-effectiveness ratio (ICER) of CHF 475,299/QALY. Pembrolizumab in comparison to chemotherapy was estimated to generate mean incremental QALYs of 0.83 and incremental costs of CHF 56,585, resulting in an ICER of CHF 68,580/QALY. Results were most sensitive to changes in costs of 1L pembrolizumab and combination therapy, together with changes in PFS. In the probabilistic sensitivity analysis, we estimated combination therapy was cost-effective in 4.9% of the simulations and pembrolizumab monotherapy in 82.9%, assuming a willingness-to-pay threshold of CHF 100,000 per QALY gained.
Pembrolizumab is likely to be cost-effective from the Swiss healthcare payer perspective, whereas pembrolizumab plus chemotherapy is not.
帕博利珠单抗单药治疗或联合化疗是两种新的治疗选择，适用于高（≥50%）程序性死亡配体 1（PD-L1）表达的转移性非鳞状非小细胞肺癌（NSCLC）患者。我们针对瑞士进行了一项成本效益分析，比较了这两种选择，以及帕博利珠单抗与化疗。
我们构建了一个 3 状态 Markov 模型，时间范围为 10 年。使用 KN-024 和 KN-189 注册试验的 2 年随访数据，通过 Kaplan-Meier 总生存（OS）和无进展生存（PFS）拟合参数函数。我们纳入了进一步治疗线的估计成本和最佳支持性护理的成本。成本从瑞士医疗保健支付者的角度进行评估。我们使用了已发表的效用值。
与帕博利珠单抗相比，联合治疗预计每个患者可获得 0.17 个质量调整生命年（QALY）的预期收益和 81085 瑞士法郎（CHF）的增量成本。这些估计导致增量成本效益比（ICER）为 CHF 475299/QALY。与化疗相比，帕博利珠单抗估计可产生 0.83 个平均增量 QALY 和 56585 CHF 的增量成本，导致 ICER 为 CHF 68580/QALY。结果对 1L 帕博利珠单抗和联合治疗的成本以及 PFS 的变化最为敏感。在概率敏感性分析中，我们估计在假设愿意支付每获得 1 个 QALY 的 CHF 100000 为阈值的情况下，联合治疗在 4.9%的模拟中具有成本效益，而帕博利珠单抗单药治疗在 82.9%的模拟中具有成本效益。
从瑞士医疗保健支付者的角度来看，帕博利珠单抗可能具有成本效益，而帕博利珠单抗联合化疗则不然。
