Cost-effectiveness of pembrolizumab as first-line therapy for advanced non-small cell lung cancer
Cost-effectiveness of pembrolizumab as first-line therapy for advanced non-small cell lung cancer
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DOI：
10.1016/j.lungcan.2018.08.018
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发表时间：
2018-10-01
期刊：
影响因子：
5.3
通讯作者：
Haaland, Benjamin
中科院分区：
文献类型：
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作者：
Georgieva, Mina;da Silveira Nogueira Lima, Joao P.;Haaland, Benjamin
背景抗PD-1免疫疗法极大地改变了晚期非小细胞肺癌（NSCLC）的治疗前景。我们评估了抗PD-1抗体pembrolizumab与铂双联化疗相比作为晚期NSCLC一线治疗的成本效益。方法：我们从KEYNOTE-024中检索了比较一线pembrolizumab与铂双联治疗PD-L1表达>= 50%、非突变EGFR和非易位ALK的晚期NSCLC患者的生存率、进展和安全性数据。联合王国和美国公布的成本为增量成本效益比提供了信息。我们的分析是基于贝叶斯马尔可夫模型的疾病与整个生命周期的地平线。我们以美元估算成本，并将有效性总结为质量调整生命年（QALs）。结果：接受帕博利珠单抗治疗的患者累积了1.80 QALs（95%CrI 1.56-1.89），结果之间存在中度依赖性，而化疗患者累积了1.06 QALs（0.94-L13）。从英国国家卫生系统（NHS）的角度来看，ICER为5.2万美元（4.3万美元-6.9万美元），高于4.2万美元的阈值，而从美国成本的角度来看，ICER为4.9万美元（$40，000-$67，000），低于假设的100，000美元阈值。结论：有证据表明，尽管在美国和英国的ICER值非常相似，但一线pembrolizumab治疗NSCLC在美国可能具有成本效益，而在英国则不然。
Background Anti-PD-1 immunotherapy has dramatically shifted therapeutic perspectives for advanced non-small cell lung cancer (NSCLC). We assessed cost-effectiveness of anti-PD-1 antibody pembrolizumab compared to platinum-doublet chemotherapy as first-line therapy for advanced NSCLC.Methods: We retrieved survival, progression, and safety data comparing first-line pembrolizumab to platinumdoublets for advanced NSCLC patients with PD-Ll expression >= 50%, non-mutated EGFR, and non-translocated ALK, from KEYNOTE-024. Published United Kingdom (UK) and United States (US) costs informed incremental cost-effectiveness ratios (ICERs). Our analysis was based on a Bayesian Markov model of disease with full lifetime horizon. We estimated costs in USD and summarized effectiveness as quality-adjusted life-years (QALYs).Results: Patients treated with pembrolizumab accumulated 1.80 QALYs (95% CrI 1.56-1.89), for moderate dependency between outcomes, compared to 1.06 QALYs (0.94-L13) with chemotherapy. From a British National Health System (NHS) perspective, the ICER was $52k ($43k-$69k) per end-of-life (EoL) adjusted QALY gained, above the 42k USD threshold, while from a US cost perspective, the ICER was $49k ($40k-67k) per EoL adjusted QALY, below the hypothetical 100k USD threshold.Conclusions: Evidence suggests first-line pembrolizumab for NSCLC may be cost-effective in the US but not the UK, in spite of very similar ICER values in both countries.