Pöllinger Bernadette, Haiderali Amin, Huang Min, Akyol Ersoy Burcu, Abdelaziz Ahmed H, Kassem Loay, Elsisi Gihan Hamdy
Center for Outcomes Research and Health Economy, MSD Sharp & Dohme GmbH, Munich, Germany.
Center for Outcomes Research and Health Economy, Merck & Co., Inc, Rahway, NJ, USA.
J Med Econ. 2025 Dec;28(1):105-113. doi: 10.1080/13696998.2024.2441073. Epub 2025 Jan 3.
The cost-effectiveness of neoadjuvant pembrolizumab + chemotherapy followed by adjuvant pembrolizumab compared to neoadjuvant chemotherapy plus placebo followed by adjuvant placebo was assessed in high-risk, early-stage, triple-negative breast cancer patients from an Egyptian societal perspective over a lifetime horizon.
A 4-state Markov cohort model was developed to compare the cost-effectiveness of pembrolizumab + chemotherapy/pembrolizumab vs chemotherapy alone for the treatment of high-risk, early-stage, triple-negative breast cancer. The model simulated the clinical course of high-risk, early-stage, triple-negative breast cancer across four health states: event-free survival, locoregional recurrence, distant metastasis, and death. Clinical inputs for the simulation were derived from modeling of efficacy and safety data collected in the KEYNOTE-522 trial. Direct medical costs and indirect costs were reported in 2022 Egyptian pounds (EGP) and converted to US dollars ($). Probabilistic and deterministic sensitivity analyses were conducted to assess the robustness of model results.
Compared with chemotherapy alone, pembrolizumab + chemotherapy/pembrolizumab led to expected gains of 2.92 life years and 2.25 quality-adjusted life years, respectively, while increasing overall treatment costs by EGP 491,695 ($102,436). Incremental costs per year gained were EGP 218,285 ($45,476) per quality-adjusted life year and EGP 168,223 ($35,046) per life year, both of which were lower than the 2022 Egyptian cost-effectiveness threshold of EGP 398,439 ($83,008). The findings of sensitivity analyses indicated that the model was robust across a range of inputs and assumptions.
In Egypt, pembrolizumab + chemotherapy/pembrolizumab is a cost-effective treatment for high-risk, early-stage, triple-negative breast cancer when considering health-related quality-of-life and years of life gained.
从埃及社会视角出发，在终身范围内评估新辅助帕博利珠单抗联合化疗后序贯辅助帕博利珠单抗与新辅助化疗加安慰剂后序贯辅助安慰剂相比，在高危、早期三阴性乳腺癌患者中的成本效益。
建立一个四状态马尔可夫队列模型，以比较帕博利珠单抗联合化疗/帕博利珠单抗与单纯化疗治疗高危、早期三阴性乳腺癌的成本效益。该模型模拟了高危、早期三阴性乳腺癌在四个健康状态下的临床病程：无事件生存、局部区域复发、远处转移和死亡。模拟的临床输入数据来自KEYNOTE-522试验中收集的疗效和安全性数据建模。直接医疗成本和间接成本以2022年埃及镑（EGP）报告，并换算为美元（$）。进行概率和确定性敏感性分析以评估模型结果的稳健性。
与单纯化疗相比，帕博利珠单抗联合化疗/帕博利珠单抗分别导致预期增加2.92个生命年和2.25个质量调整生命年，同时使总体治疗成本增加491,695埃及镑（102,436美元）。每获得一个质量调整生命年的增量成本为218,285埃及镑（45,476美元），每获得一个生命年的增量成本为168,223埃及镑（35,046美元），两者均低于2022年埃及成本效益阈值398,439埃及镑（83,008美元）。敏感性分析结果表明，该模型在一系列输入和假设条件下都很稳健。
在埃及，考虑到与健康相关的生活质量和获得的生命年数，帕博利珠单抗联合化疗/帕博利珠单抗是高危、早期三阴性乳腺癌的一种具有成本效益的治疗方法。
