Cost-effectiveness of cemiplimab plus chemotherapy vs pembrolizumab plus chemotherapy as first-line treatment for advanced non-small cell lung cancer.

IF 2.3 4区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of managed care & specialty pharmacy Pub Date : 2025-02-01 DOI:10.18553/jmcp.2025.31.2.137

Xiangzhong Xue, Surachat Ngorsuraches, Brandon Johnson, Jingyi Zheng, Jingjing Qian

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引用次数: 0

Abstract

Background: In 2022, the US Food and Drug Administration approved cemiplimab in combination with chemotherapy (CCT) as a first-line treatment for advanced non-small cell lung cancer (aNSCLC). However, whether CCT presents a cost-effective alternative to the previously preferred first-line treatment, pembrolizumab plus chemotherapy (PCT), remains uncertain.

Objective: To evaluate the cost-effectiveness of CCT vs PCT as the first-line treatment for aNSCLC from a US health care payer perspective.

Methods: A 3-state partitioned survival model with a 10-year horizon was constructed. Clinical data were derived from the EMPOWER-Lung 3, KEYNOTE-407, and KEYNOTE-189 trials. Costs and quality of life were obtained from published 2024 US list prices and literature. The cost, quality-adjusted life-years (QALYs) gained, and incremental cost-effectiveness ratio (ICER) were calculated. All outcomes were discounted at a rate of 3% per year. Scenario analyses, deterministic and probabilistic sensitivity analyses, and subgroup analyses were performed for patients with different programmed death ligand 1 (PD-L1) levels.

Results: In the base-case analysis, the total cost of PCT was $207,926 with 1.609 QALYs, whereas CCT had a total cost of $175,247 with 1.657 QALYs. Results from the scenario analyses were consistent with the base-case analysis, indicating that CCT was a dominant treatment strategy over PCT (ICER =-$675,304 per QALY). The cost of pembrolizumab highly impacted the ICER. At a willingness-to-pay threshold of $150,000 per QALY, CCT would be accepted as a cost-effective option 96.9% of the time. In subgroup analyses, CCT remained a dominant alternative to PCT for patients with PD-L1 levels of at least 50% and 1%-49%.

Conclusions: This cost-effectiveness analysis suggests that CCT is a dominant first-line treatment option for aNSCLC with PD-L1 levels of at least 1% compared with PCT.

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作为晚期非小细胞肺癌一线治疗方案，塞米单抗联合化疗vs派姆单抗联合化疗的成本效益

背景：2022年，美国食品和药物管理局（fda）批准了cemiplimab联合化疗（CCT）作为晚期非小细胞肺癌（aNSCLC）的一线治疗药物。然而，CCT是否为先前首选的一线治疗——派姆单抗加化疗（PCT）——提供了一种具有成本效益的替代方案，仍不确定。目的：从美国医疗支付者的角度评估CCT与PCT作为一线治疗aNSCLC的成本效益。方法：建立10年视界的三状态分区生存模型。临床数据来自EMPOWER-Lung 3、KEYNOTE-407和KEYNOTE-189试验。成本和生活质量是根据2024年美国公布的价格和文献得出的。计算成本、获得的质量调整寿命年（QALYs）和增量成本-效果比（ICER）。所有结果以每年3%的比率贴现。对不同程序性死亡配体1 （PD-L1）水平的患者进行情景分析、确定性和概率敏感性分析以及亚组分析。结果：在基本病例分析中，PCT的总成本为207,926美元，QALYs为1.609，而CCT的总成本为175,247美元，QALYs为1.657。情景分析的结果与基本病例分析一致，表明CCT是PCT的主要治疗策略（ICER =- 675,304美元/ QALY）。派姆单抗的成本高度影响ICER。在每个QALY的支付意愿阈值为15万美元时，有条件现金转移治疗将被接受为96.9%的成本效益选择。在亚组分析中，对于PD-L1水平至少为50%和1%-49%的患者，CCT仍然是PCT的主要替代方案。结论：该成本-效果分析表明，与PCT相比，对于PD-L1水平至少为1%的aNSCLC， CCT是主要的一线治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of managed care & specialty pharmacy Health Professions-Pharmacy

CiteScore

3.50

自引率

4.80%

发文量

131

期刊介绍： JMCP welcomes research studies conducted outside of the United States that are relevant to our readership. Our audience is primarily concerned with designing policies of formulary coverage, health benefit design, and pharmaceutical programs that are based on evidence from large populations of people. Studies of pharmacist interventions conducted outside the United States that have already been extensively studied within the United States and studies of small sample sizes in non-managed care environments outside of the United States (e.g., hospitals or community pharmacies) are generally of low interest to our readership. However, studies of health outcomes and costs assessed in large populations that provide evidence for formulary coverage, health benefit design, and pharmaceutical programs are of high interest to JMCP’s readership.