Cost-Effectiveness of Pembrolizumab in Combination with Platinum-Based Chemotherapy in First-Line for Squamous and Nonsquamous Non Small-Cell Lung Cancer. Far from Economic Sustainability
Objectives: To assess the pharmacological costs of pembrolizumab in association with chemotherapy as first-line treatment in non small-cell lung cancer (NSCLC).
Methods: Pivotal phase III randomized controlled trials (RCTs) were considered. Differences in progression free survival (PFS) between the different arms were calculated and compared with the pharmacological costs needed to get one month of PFS (incremental cost-effectiveness ratio, ICER).
Results: One thousand one hundred and seventy five patients were included.Differences in costs between the 2 arms with the use of pembrolizumab were 37 009 € for squamous NSCLC and 45 234 € for nonsquamous NSCLC, with a cost of 23 131 € and 11 598 € per month of PFS-gain in the overall population for squamous and nonsquamous NSCLC, respectively and with a progressively lower cost per month of PFS-gain in the transition from PD-L1< 1% (37 009 €) to PD-L1 of 1 to 49% (18 505 €) to PD-L1≥ 50% (9739 €) in squamous and NSCLC.
Conclusion: At the actual prize, pembrolizumab in combination with chemotherapy is not cost-effective in first-line for both squamous and nonsquamous NSCLC. A reduction in pharmacy cost is mandatory
1.Giuliani J, Bonetti A. The Economic Impact of Biosimilars in Oncology and Hematology: The Case of Trastuzumab and Rituximab. Anticancer Res 2019;39:3971-3. [CrossRef]
2. Paz-Ares L, Luft A, Vicente D, et al. Pembrolizumab plus Chemotherapy for Squamous Non-Small-Cell Lung Cancer. N Engl J Med 2018;379:2040-51. [CrossRef]
3. Gandhi L, Rodríguez-Abreu D, Gadgeel S, et al. Pembrolizumab plus Chemotherapy in Metastatic Non-Small-Cell Lung Cancer. N Engl J Med 2018;378:2078-92. [CrossRef]
4. Cherny NI, Sullivan R, Dafni U, et al. A standardised, generic, validated approach to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies: the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS). Ann Oncol 2015;26:1547-73. [CrossRef]
5. Giuliani J, Bonetti A. Which grade is of clinical benefit in the randomised controlled trials? The example of 54th American Society of Clinical Oncology annual meeting, 2018. Eur J Cancer 2018;104:233-5. [CrossRef]
6. Giuliani J, Fiorica F, Albanese V, et al. Financial toxicity and cancer treatments: Help from biosimilars - The explanatory case of bevacizumab. Eur J Cancer 2020;143:40-2. [CrossRef]
7. Hofmarcher T, Lindgren P, Wilking N, Jönsson B. The cost of cancer in Europe 2018. Eur J Cancer 2020;129:41-9. [CrossRef]
8. Azimi NA, Welch HG. The effectiveness of cost-effectiveness analysis in containing costs. J Gen Intern Med 1998;13:664.
9. Giuliani J, Bonetti A. Financial Toxicity and Non-small Cell Lung Cancer Treatment: The Optimization in the Choice of Immune Check Point Inhibitors. Anticancer Res 2019;39:3961-5.
10. Giuliani J, Bonetti A. Immunotherapy in first-line for advanced non-small cell lung cancer: a cost-effective choice? Recenti Prog Med 2019;110:138-43.
11. Giuliani J, Bonetti A. Immune-checkpoint inhibitors in head and neck squamous cell carcinoma: cost-efficacy in secondline treatment based on programmed death-ligand 1 (PD-L1) level. Oral Oncol 2019;97:143-5. [CrossRef]
12. Giuliani J, Bonetti A. Nivolumab in Second-Line Treatment for Advanced Non-Small-Cell Lung Cancer With Squamous-Cell Histology: A Perspective Based on Pharmacologic Costs. Clin Lung Cancer 2017;18:e363-5. [CrossRef]
13. Giuliani J, Bonetti A. Nivolumab Is a Cost-Effective SecondLine Treatment for Metastatic Renal-Cell Carcinoma. Clin Genitourin Cancer 2018;16:e557-62. [CrossRef]