Health Economic Analysis, Lumanity, Sheffield, UK.
Merck Research Laboratories, Merck & Co., Inc, Rahway, NJ, USA.
J Med Econ. 2024 Jan-Dec;27(1):483-491. doi: 10.1080/13696998.2024.2329022. Epub 2024 Mar 26.
Pembrolizumab plus lenvatinib was recently approved for the treatment of advanced or recurrent endometrial carcinoma in women with disease progression on or following prior treatment with a platinum‑containing therapy in any setting, and who are not candidates for curative surgery or radiation (KEYNOTE-775/Study-309; NCT03517449). The objective was to assess the cost effectiveness of pembrolizumab plus lenvatinib compared with chemotherapy from a Swedish healthcare perspective.
A lifetime partitioned-survival model with three health states (progression free, progressed disease, death) was constructed. Chemotherapy was represented by paclitaxel or doxorubicin. Overall survival, progression-free survival, time on treatment, and utility data were obtained from KEYNOTE-775 (database lock: March 1, 2022). Costs (in 2020 Swedish Krona [SEK]) included drug acquisition and administration, health state, end of life, adverse event management, subsequent treatment, and societal (scenario analysis). Outcomes were calculated as quality-adjusted life-years (QALY) and life-years. Model results were presented as incremental cost-effectiveness ratios for all-comers, patients with proficient mismatch repair tumors, and deficient mismatch repair tumors. Deterministic and probabilistic sensitivity analyses were conducted.
Pembrolizumab plus lenvatinib is a cost-effective treatment when compared with chemotherapy, with estimated deterministic and probabilistic incremental cost-effectiveness ratios of SEK 795,712 and 819,757 per QALY gained. Pembrolizumab plus lenvatinib was associated with a large incremental QALY and life-year gain per person versus chemotherapy over the model time horizon (1.49 and 1.76).
Time-to-event data were incomplete and semiparametric and parametric curves were utilized for lifetime extrapolation. Willingness-to-pay thresholds, costs, and utility weights vary by country, which would vary the treatment's cost effectiveness in different countries.
This partitioned survival analysis suggests that pembrolizumab plus lenvatinib is cost effective compared with chemotherapy in Sweden for women with advanced or recurrent endometrial carcinoma following previous systemic therapy. Results were robust to mismatch repair status and to changes in parameters/assumptions.
帕博利珠单抗联合仑伐替尼最近被批准用于治疗晚期或复发性子宫内膜癌，这些患者在任何情况下均因疾病进展而接受过含铂化疗，且不适合进行根治性手术或放疗（KEYNOTE-775/Study-309；NCT03517449）。本研究旨在从瑞典医疗保健的角度评估帕博利珠单抗联合仑伐替尼相对于化疗的成本效益。
构建了一个具有三个健康状态（无进展生存期、疾病进展期、死亡）的终身分割生存模型。化疗以紫杉醇或多柔比星为代表。总生存期、无进展生存期、治疗时间和效用数据来自 KEYNOTE-775（数据库锁定：2022 年 3 月 1 日）。成本（2020 年瑞典克朗[SEK]）包括药物获得和管理、健康状态、生命终末期、不良事件管理、后续治疗和社会（情景分析）。结果以质量调整生命年（QALY）和生命年表示。模型结果以所有患者、 proficient mismatch repair 肿瘤患者和 deficient mismatch repair 肿瘤患者的增量成本效益比呈现。进行了确定性和概率敏感性分析。
与化疗相比，帕博利珠单抗联合仑伐替尼治疗具有成本效益，估计所有患者、 proficient mismatch repair 肿瘤患者和 deficient mismatch repair 肿瘤患者的增量成本效益比分别为 SEK 795,712 和 819,757 每获得一个 QALY。与化疗相比，帕博利珠单抗联合仑伐替尼在模型时间范围内每例患者的增量 QALY 和生命年获益较大（1.49 和 1.76）。
生存时间数据不完整，采用半参数和参数曲线进行终生外推。支付意愿阈值、成本和效用权重因国家而异，这将使不同国家的治疗成本效益有所不同。
本分割生存分析表明，对于先前接受过系统治疗的晚期或复发性子宫内膜癌女性，在瑞典，帕博利珠单抗联合仑伐替尼相对于化疗具有成本效益。结果对 mismatch repair 状态和参数/假设的变化具有稳健性。
