[Adjuvant immunotherapy with pembrolizumab for renal cell carcinoma-is the new standard of care cost-effective?? : A health economic analysis].

Background: Adjuvant pembrolizumab decreases the risk of recurrence and prolongs survival after surgery for high-risk clear cell renal cell carcinoma. Cost-effectiveness analyses evaluate therapy associated risks, toxicity, quality of life, costs of therapies and follow-up regimens and represent an essential adjunct for the evaluation of new therapies. At present, there is no cost effectiveness analysis for adjuvant pembrolizumab within the German healthcare system.

Methods: A Markov model was used to evaluate cost-effectiveness. The impact of variables on the cost-effectiveness of therapy were investigated with one-way deterministic and probabilistic sensitivity analysis and thresholds were determined.

Results: The adjuvant treatment with pembrolizumab was cost-effective over a 5-year period, with an ICER (incremental cost-effectiveness ratio) of 68,278 €/QALY (quality-adjusted life year) assuming a WTP (willingness to pay) threshold of 100,000 €/QALY.

Conclusion: Adjuvant treatment in high-risk patients with pembrolizumab has been shown to be cost-effective when applied within the German health system. It should therefore be offered to all patients with an increased risk for recurrence after curative surgery.