KEY TAKEAWAYS
- The phase 3 clinical trial KEYNOTE-590 evaluated the efficacy and cost-effectiveness of Pembrolizumab in combination with chemotherapy as the initial treatment regimen for advanced esophageal cancer.
- The trial’s primary aim was to improve the overall survival rate of patients diagnosed with advanced esophageal cancer.
- The method employed a Markov model simulation to estimate the 10-year survival rate of patients, taking into account the viewpoint of US Medicare payers.
- The outcome revealed that the intervention of Pembrolizumab in combination with chemotherapy was not cost-effective, with an ICER of $293,513.17 per QALY.
- The cost-effectiveness analysis showed that the intervention surpassed the willingness-to-pay threshold of $150,000 per QALY.
- Sensitivity analyses demonstrated that the ICERs were highly sensitive to the cost of Pembrolizumab, and the intervention was not recommended as a cost-effective treatment option for advanced esophageal cancer in the United States.
The clinical trial KEYNOTE-590 demonstrated that patients diagnosed with advanced esophageal cancer who were administered Pembrolizumab in conjunction with chemotherapy as their initial treatment regimen experienced a noteworthy increase in their overall survival. However, this treatment option increases the financial burden on patients, and the economic benefits remain to be further evaluated. A Markov simulation was employed to estimate the 10-year survival rate of individuals afflicted with esophageal cancer, considering US Medicare payers’ viewpoint. The economic assessment of Pembrolizumab in combination with chemotherapy was conducted for patients with a PD-L1 positive score (CPS ≥10) and those with any level of PD-L1 expression. Researchers estimated the overall expenses and quality-adjusted life years (QALYs) and determined incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to investigate the influence of uncertainties on the outcomes. A subgroup analysis was conducted.
According to the analysis results, the ICER for pembrolizumab combined with chemotherapy alone was $293,513.17 per quality-adjusted life year (QALY) combined with chemotherapy in the group of patients with any level of PD-L1 expression. The cost-effectiveness analysis indicated that the intervention surpassed the willingness-to-pay threshold of $150,000 per quality-adjusted life year (QALY). The incremental cost-effectiveness ratios (ICERs) demonstrated a high sensitivity to the cost of pembrolizumab, with values exceeding $150,000 per quality-adjusted life year (QALY) across all subgroups. Based on available evidence, using first-line pembrolizumab in combination with chemotherapy is not recommended as a cost-effective treatment option for advanced esophageal cancer in the United States, irrespective of the PD-L1 expression status.
Source: https://onlinelibrary.wiley.com/doi/10.1002/cam4.5350#cam45350-tbl-0001
Clinical Trail: https://clinicaltrials.gov/ct2/show/NCT03189719
Ye, Z., Xu, Z., Wang, H., Wang, Y., Chen, Z., Zhou, Q., Li, X., & Zhang, Y. (2022)/ Cost‐effectiveness analysis of pembrolizumab plus chemotherapy versus chemotherapy as the first‐line treatment for advanced esophageal cancer. Cancer Medicine/ https://doi.org/10.1002/cam4.5350
