Cost-effectiveness of pembrolizumab in combination with chemotherapy in the 1st line treatment of non-squamous NSCLC in the US
Aims: To describe cost-effectiveness of pembrolizumab plus platinum and pemetrexed chemotherapy in metastatic, non-squamous, NSCLC patients in the US. Materials and methods: A model is developed utilizing partitioned survival analysis to estimate the cost-effectiveness of KEYNOTE-189 trial comparato...
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| Veröffentlicht in: | Journal of medical economics 2018-12, Vol.21 (12), p.1191-1205 |
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| creator | Insinga, Ralph P. Vanness, David J. Feliciano, Josephine L. Vandormael, Kristel Traore, Sory Burke, Thomas |
| description | Aims: To describe cost-effectiveness of pembrolizumab plus platinum and pemetrexed chemotherapy in metastatic, non-squamous, NSCLC patients in the US.
Materials and methods: A model is developed utilizing partitioned survival analysis to estimate the cost-effectiveness of KEYNOTE-189 trial comparators pembrolizumab + chemotherapy (carboplatin/cisplatin + pemetrexed) vs chemotherapy alone. Clinical efficacy, treatment utilization, health utility, and safety data are derived from the trial and projected over 20 years. For extrapolating survival beyond the trial, a novel SEER population-data approach is applied (primary analysis), with separate estimation via traditional parametric extrapolation methods. Costs for drugs and non-drug disease management are also incorporated. Based on an indirect treatment comparison, cost-effectiveness of pembrolizumab + chemotherapy vs pembrolizumab monotherapy is evaluated for patients with programmed death-ligand 1 (PD-L1) ≥ 50%.
Results: In the full non-squamous population, pembrolizumab + chemotherapy is projected to increase life expectancy by 2.04 years vs chemotherapy (3.96 vs 1.92), for an approximate doubling of life years. Resultant incremental cost-effectiveness ratios (ICERs) are $104,823/QALY and $87,242/life year. In patients with PD-L1 ≥ 50% and 1-49%, life expectancy is more than doubled (4.53 vs 1.88 years) and (4.87 vs 2.01 years), with a 32% (2.60 vs 1.97 years) increase in PD-L1 |
| doi_str_mv | 10.1080/13696998.2018.1521416 |
| format | Article |
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Materials and methods: A model is developed utilizing partitioned survival analysis to estimate the cost-effectiveness of KEYNOTE-189 trial comparators pembrolizumab + chemotherapy (carboplatin/cisplatin + pemetrexed) vs chemotherapy alone. Clinical efficacy, treatment utilization, health utility, and safety data are derived from the trial and projected over 20 years. For extrapolating survival beyond the trial, a novel SEER population-data approach is applied (primary analysis), with separate estimation via traditional parametric extrapolation methods. Costs for drugs and non-drug disease management are also incorporated. Based on an indirect treatment comparison, cost-effectiveness of pembrolizumab + chemotherapy vs pembrolizumab monotherapy is evaluated for patients with programmed death-ligand 1 (PD-L1) ≥ 50%.
Results: In the full non-squamous population, pembrolizumab + chemotherapy is projected to increase life expectancy by 2.04 years vs chemotherapy (3.96 vs 1.92), for an approximate doubling of life years. Resultant incremental cost-effectiveness ratios (ICERs) are $104,823/QALY and $87,242/life year. In patients with PD-L1 ≥ 50% and 1-49%, life expectancy is more than doubled (4.53 vs 1.88 years) and (4.87 vs 2.01 years), with a 32% (2.60 vs 1.97 years) increase in PD-L1 < 1% patients. Corresponding incremental costs/quality-adjusted life year (QALY) are $103,402, $66,837, and $183,529 for PD-L1 ≥ 50%, 1-49%, and <1% groups, respectively. Versus pembrolizumab monotherapy in PD-L1 ≥ 50% patients, representing current standard of care, pembrolizumab + chemotherapy increases life expectancy by 65% (4.53 vs 2.74 years) at an ICER of $147,365/QALY.
Limitations and conclusions: The addition of pembrolizumab to chemotherapy is projected to extend life expectancy to a point not previously seen in previously untreated metastatic non-squamous NSCLC. Although ICERs vary by sub-group and comparator, results suggest pembrolizumab + chemotherapy yields ICERs near, or in most cases, well below a 3-times US per capita GDP threshold of $180,000/QALY, and may be a cost-effective first-line treatment for metastatic non-squamous NSCLC patients.</description><identifier>ISSN: 1369-6998</identifier><identifier>EISSN: 1941-837X</identifier><identifier>DOI: 10.1080/13696998.2018.1521416</identifier><identifier>PMID: 30188231</identifier><language>eng</language><publisher>England: Taylor & Francis</publisher><subject>Adult ; Aged ; Antibodies, Monoclonal, Humanized - administration & dosage ; Antibodies, Monoclonal, Humanized - economics ; Antibodies, Monoclonal, Humanized - therapeutic use ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Carcinoma, Non-Small-Cell Lung - drug therapy ; Carcinoma, Non-Small-Cell Lung - mortality ; Carcinoma, Non-Small-Cell Lung - pathology ; chemotherapy ; Cost-Benefit Analysis ; cost-effectiveness ; Disease-Free Survival ; Double-Blind Method ; Female ; Health Expenditures - statistics & numerical data ; Humans ; Lung cancer ; Lung Neoplasms - drug therapy ; Lung Neoplasms - mortality ; Lung Neoplasms - pathology ; Male ; Middle Aged ; Models, Econometric ; Neoplasm Metastasis ; pembrolizumab ; Pemetrexed - economics ; Pemetrexed - therapeutic use ; Platinum Compounds - economics ; Platinum Compounds - therapeutic use ; Quality-Adjusted Life Years ; Survival Analysis ; United States</subject><ispartof>Journal of medical economics, 2018-12, Vol.21 (12), p.1191-1205</ispartof><rights>2018 Informa UK Limited, trading as Taylor & Francis Group 2018</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c366t-b62124f7d0e9f97b0c83f8c1414d9b6f004324ad52984486261c93393bd9a4c83</citedby><cites>FETCH-LOGICAL-c366t-b62124f7d0e9f97b0c83f8c1414d9b6f004324ad52984486261c93393bd9a4c83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27902,27903</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30188231$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Insinga, Ralph P.</creatorcontrib><creatorcontrib>Vanness, David J.</creatorcontrib><creatorcontrib>Feliciano, Josephine L.</creatorcontrib><creatorcontrib>Vandormael, Kristel</creatorcontrib><creatorcontrib>Traore, Sory</creatorcontrib><creatorcontrib>Burke, Thomas</creatorcontrib><title>Cost-effectiveness of pembrolizumab in combination with chemotherapy in the 1st line treatment of non-squamous NSCLC in the US</title><title>Journal of medical economics</title><addtitle>J Med Econ</addtitle><description>Aims: To describe cost-effectiveness of pembrolizumab plus platinum and pemetrexed chemotherapy in metastatic, non-squamous, NSCLC patients in the US.
Materials and methods: A model is developed utilizing partitioned survival analysis to estimate the cost-effectiveness of KEYNOTE-189 trial comparators pembrolizumab + chemotherapy (carboplatin/cisplatin + pemetrexed) vs chemotherapy alone. Clinical efficacy, treatment utilization, health utility, and safety data are derived from the trial and projected over 20 years. For extrapolating survival beyond the trial, a novel SEER population-data approach is applied (primary analysis), with separate estimation via traditional parametric extrapolation methods. Costs for drugs and non-drug disease management are also incorporated. Based on an indirect treatment comparison, cost-effectiveness of pembrolizumab + chemotherapy vs pembrolizumab monotherapy is evaluated for patients with programmed death-ligand 1 (PD-L1) ≥ 50%.
Results: In the full non-squamous population, pembrolizumab + chemotherapy is projected to increase life expectancy by 2.04 years vs chemotherapy (3.96 vs 1.92), for an approximate doubling of life years. Resultant incremental cost-effectiveness ratios (ICERs) are $104,823/QALY and $87,242/life year. In patients with PD-L1 ≥ 50% and 1-49%, life expectancy is more than doubled (4.53 vs 1.88 years) and (4.87 vs 2.01 years), with a 32% (2.60 vs 1.97 years) increase in PD-L1 < 1% patients. Corresponding incremental costs/quality-adjusted life year (QALY) are $103,402, $66,837, and $183,529 for PD-L1 ≥ 50%, 1-49%, and <1% groups, respectively. Versus pembrolizumab monotherapy in PD-L1 ≥ 50% patients, representing current standard of care, pembrolizumab + chemotherapy increases life expectancy by 65% (4.53 vs 2.74 years) at an ICER of $147,365/QALY.
Limitations and conclusions: The addition of pembrolizumab to chemotherapy is projected to extend life expectancy to a point not previously seen in previously untreated metastatic non-squamous NSCLC. Although ICERs vary by sub-group and comparator, results suggest pembrolizumab + chemotherapy yields ICERs near, or in most cases, well below a 3-times US per capita GDP threshold of $180,000/QALY, and may be a cost-effective first-line treatment for metastatic non-squamous NSCLC patients.</description><subject>Adult</subject><subject>Aged</subject><subject>Antibodies, Monoclonal, Humanized - administration & dosage</subject><subject>Antibodies, Monoclonal, Humanized - economics</subject><subject>Antibodies, Monoclonal, Humanized - therapeutic use</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Carcinoma, Non-Small-Cell Lung - drug therapy</subject><subject>Carcinoma, Non-Small-Cell Lung - mortality</subject><subject>Carcinoma, Non-Small-Cell Lung - pathology</subject><subject>chemotherapy</subject><subject>Cost-Benefit Analysis</subject><subject>cost-effectiveness</subject><subject>Disease-Free Survival</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>Health Expenditures - statistics & numerical data</subject><subject>Humans</subject><subject>Lung cancer</subject><subject>Lung Neoplasms - drug therapy</subject><subject>Lung Neoplasms - mortality</subject><subject>Lung Neoplasms - pathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Models, Econometric</subject><subject>Neoplasm Metastasis</subject><subject>pembrolizumab</subject><subject>Pemetrexed - economics</subject><subject>Pemetrexed - therapeutic use</subject><subject>Platinum Compounds - economics</subject><subject>Platinum Compounds - therapeutic use</subject><subject>Quality-Adjusted Life Years</subject><subject>Survival Analysis</subject><subject>United States</subject><issn>1369-6998</issn><issn>1941-837X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE2PFCEQhonRuJt1f4KGo5ce-RoabpqOqyYTPaybeCM0DRlMA7NAuxkP_nbpzIxH61J1eN4qeAB4jdEGI4HeYcoll1JsCMJig7cEM8yfgWssGe4E7X88b3NjuhW6Arel_EStKMWoxy_BFW0xQSi-Bn-GVGpnnbOm-l822lJgcvBgw5jT7H8vQY_QR2hSGH3U1acIn3zdQ7O3IdW9zfpwXIE2QlwqnH20sGara7Cxrrtiil15XHRIS4Ff74fdcOEf7l-BF07Pxd6e-w14uPv4ffjc7b59-jJ82HWGcl67kRNMmOsnZKWT_YiMoE6Y9ms2yZE7hBglTE9bIgVjghOOjaRU0nGSmjX4Brw97T3k9LjYUlXwxdh51tG2ZymCmx0iUM8auj2hJqdSsnXqkH3Q-agwUqt9dbGvVvvqbL_l3pxPLGOw07_UxXUD3p8AH13KQT-lPE-q6uOcsss6Gl8U_f-Nvxmmk_M</recordid><startdate>20181202</startdate><enddate>20181202</enddate><creator>Insinga, Ralph P.</creator><creator>Vanness, David J.</creator><creator>Feliciano, Josephine L.</creator><creator>Vandormael, Kristel</creator><creator>Traore, Sory</creator><creator>Burke, Thomas</creator><general>Taylor & Francis</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20181202</creationdate><title>Cost-effectiveness of pembrolizumab in combination with chemotherapy in the 1st line treatment of non-squamous NSCLC in the US</title><author>Insinga, Ralph P. ; Vanness, David J. ; Feliciano, Josephine L. ; Vandormael, Kristel ; Traore, Sory ; Burke, Thomas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c366t-b62124f7d0e9f97b0c83f8c1414d9b6f004324ad52984486261c93393bd9a4c83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antibodies, Monoclonal, Humanized - administration & dosage</topic><topic>Antibodies, Monoclonal, Humanized - economics</topic><topic>Antibodies, Monoclonal, Humanized - therapeutic use</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Carcinoma, Non-Small-Cell Lung - drug therapy</topic><topic>Carcinoma, Non-Small-Cell Lung - mortality</topic><topic>Carcinoma, Non-Small-Cell Lung - pathology</topic><topic>chemotherapy</topic><topic>Cost-Benefit Analysis</topic><topic>cost-effectiveness</topic><topic>Disease-Free Survival</topic><topic>Double-Blind Method</topic><topic>Female</topic><topic>Health Expenditures - statistics & numerical data</topic><topic>Humans</topic><topic>Lung cancer</topic><topic>Lung Neoplasms - drug therapy</topic><topic>Lung Neoplasms - mortality</topic><topic>Lung Neoplasms - pathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Models, Econometric</topic><topic>Neoplasm Metastasis</topic><topic>pembrolizumab</topic><topic>Pemetrexed - economics</topic><topic>Pemetrexed - therapeutic use</topic><topic>Platinum Compounds - economics</topic><topic>Platinum Compounds - therapeutic use</topic><topic>Quality-Adjusted Life Years</topic><topic>Survival Analysis</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Insinga, Ralph P.</creatorcontrib><creatorcontrib>Vanness, David J.</creatorcontrib><creatorcontrib>Feliciano, Josephine L.</creatorcontrib><creatorcontrib>Vandormael, Kristel</creatorcontrib><creatorcontrib>Traore, Sory</creatorcontrib><creatorcontrib>Burke, Thomas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of medical economics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Insinga, Ralph P.</au><au>Vanness, David J.</au><au>Feliciano, Josephine L.</au><au>Vandormael, Kristel</au><au>Traore, Sory</au><au>Burke, Thomas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cost-effectiveness of pembrolizumab in combination with chemotherapy in the 1st line treatment of non-squamous NSCLC in the US</atitle><jtitle>Journal of medical economics</jtitle><addtitle>J Med Econ</addtitle><date>2018-12-02</date><risdate>2018</risdate><volume>21</volume><issue>12</issue><spage>1191</spage><epage>1205</epage><pages>1191-1205</pages><issn>1369-6998</issn><eissn>1941-837X</eissn><abstract>Aims: To describe cost-effectiveness of pembrolizumab plus platinum and pemetrexed chemotherapy in metastatic, non-squamous, NSCLC patients in the US.
Materials and methods: A model is developed utilizing partitioned survival analysis to estimate the cost-effectiveness of KEYNOTE-189 trial comparators pembrolizumab + chemotherapy (carboplatin/cisplatin + pemetrexed) vs chemotherapy alone. Clinical efficacy, treatment utilization, health utility, and safety data are derived from the trial and projected over 20 years. For extrapolating survival beyond the trial, a novel SEER population-data approach is applied (primary analysis), with separate estimation via traditional parametric extrapolation methods. Costs for drugs and non-drug disease management are also incorporated. Based on an indirect treatment comparison, cost-effectiveness of pembrolizumab + chemotherapy vs pembrolizumab monotherapy is evaluated for patients with programmed death-ligand 1 (PD-L1) ≥ 50%.
Results: In the full non-squamous population, pembrolizumab + chemotherapy is projected to increase life expectancy by 2.04 years vs chemotherapy (3.96 vs 1.92), for an approximate doubling of life years. Resultant incremental cost-effectiveness ratios (ICERs) are $104,823/QALY and $87,242/life year. In patients with PD-L1 ≥ 50% and 1-49%, life expectancy is more than doubled (4.53 vs 1.88 years) and (4.87 vs 2.01 years), with a 32% (2.60 vs 1.97 years) increase in PD-L1 < 1% patients. Corresponding incremental costs/quality-adjusted life year (QALY) are $103,402, $66,837, and $183,529 for PD-L1 ≥ 50%, 1-49%, and <1% groups, respectively. Versus pembrolizumab monotherapy in PD-L1 ≥ 50% patients, representing current standard of care, pembrolizumab + chemotherapy increases life expectancy by 65% (4.53 vs 2.74 years) at an ICER of $147,365/QALY.
Limitations and conclusions: The addition of pembrolizumab to chemotherapy is projected to extend life expectancy to a point not previously seen in previously untreated metastatic non-squamous NSCLC. Although ICERs vary by sub-group and comparator, results suggest pembrolizumab + chemotherapy yields ICERs near, or in most cases, well below a 3-times US per capita GDP threshold of $180,000/QALY, and may be a cost-effective first-line treatment for metastatic non-squamous NSCLC patients.</abstract><cop>England</cop><pub>Taylor & Francis</pub><pmid>30188231</pmid><doi>10.1080/13696998.2018.1521416</doi><tpages>15</tpages></addata></record> |
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| subjects | Adult Aged Antibodies, Monoclonal, Humanized - administration & dosage Antibodies, Monoclonal, Humanized - economics Antibodies, Monoclonal, Humanized - therapeutic use Antineoplastic Combined Chemotherapy Protocols - therapeutic use Carcinoma, Non-Small-Cell Lung - drug therapy Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - pathology chemotherapy Cost-Benefit Analysis cost-effectiveness Disease-Free Survival Double-Blind Method Female Health Expenditures - statistics & numerical data Humans Lung cancer Lung Neoplasms - drug therapy Lung Neoplasms - mortality Lung Neoplasms - pathology Male Middle Aged Models, Econometric Neoplasm Metastasis pembrolizumab Pemetrexed - economics Pemetrexed - therapeutic use Platinum Compounds - economics Platinum Compounds - therapeutic use Quality-Adjusted Life Years Survival Analysis United States |
| title | Cost-effectiveness of pembrolizumab in combination with chemotherapy in the 1st line treatment of non-squamous NSCLC in the US |
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