![]() Risk-sharing contracts may be helpful in resolving some of the underlying uncertainty associated with the long-term survival and varying extent of patient response.Ĭost-Effectiveness Immunotherapy Non-small-cell lung cancer Pembrolizumab.Ĭopyright © 2018 Elsevier B.V. Using a willingness-to-pay threshold of £50,000, pembrolizumab is not cost-effective at its current list price and a discount of 50% or more is required for it to be cost-effective comparing to commonly prescribed chemotherapy. ![]() Probability sensitivity analyses showed that using a willingness-to-pay threshold of £50,000 per QALY, the probability of pembrolizumab being cost-effective is 29.4%. When parameters were varied in the deterministic sensitivity analyses, results are most sensitive to duration of median overall survival in both groups. 0.71) at an additional cost of £72,465, yielding an incremental cost-effectiveness ratio of £86,913/QALY. In the base case, pembrolizumab is projected to increase patient's life expectancy by 1.32 life-years over chemotherapy (2.45 vs. Participants receive paclitaxel 200 mg/m2 and carboplatin Area Under the Curve (AUC) 5 or 6, administered as IV infusion on Day 1 of each 21-day cycle for 4-6 cycles followed by optional pemetrexed 500 mg/m2 every three weeks (Q3W) maintenance for participants with non-squamous histologies for the remainder of the study or until documented PD or participant discontinuation. Deterministic and probabilistic sensitivity analyses were performed to address the uncertainties around model parameters. Both health outcomes and costs were discounted at an annual rate of 3.5%. The model was run until 99% patients died. Cost data including drug acquisition costs, disease management costs, and adverse event costs were derived from British National Formulary and published literature. Background: In the phase 3 KEYNOTE-024 trial, treatment with pembrolizumab conferred longer progression-free survival than did platinum-based therapy in patients with treatment-naive, advanced non-small-cell lung cancer (NSCLC) with a programmed cell death-ligand 1 (PD-L1) tumour proportion score of 50 or greater (PD-L1-positive). Utility values were sourced from published literature. Clinical parameters were informed by the KEYNOTE-024 trial. This analysis aimed to evaluate the cost-effectiveness of pembrolizumab as a first-line treatment for patients with PD-L1 positive NSCLC from the UK health care perspective.Ī Markov model with progression-free, progressive disease and death states was developed. Pembrolizumab has shown significant survival benefits in treating chemotherapy-naïve non-small-cell lung cancer patients (NSCLC) with increased level of PD-L1 expression.
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