Pembrolizumab More Cost Effective Than Docetaxel for PD-L1-Positive NSCLC

The associated improvement in survival and quality-adjusted life years (QALYs) makes pembrolizumab a more cost-effective option than docetaxel for patients with programmed death ligand 1 (PD-L1)-positive non-small cell lung cancer (NSCLC), according to a study published in the Journal of Medical Economics

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Pembrolizumab is part of a new line of therapies called PD-L1 inhibitors, which work by blocking the interaction between programmed cell death protein 1 (PD-1) and PD-L1 receptors, a key process associated with cancer growth. In the KEYNOTE 010 clinical trial, investigators demonstrated that pembrolizumab could improve overall survival in patients with NSCLC. Using data from that trial, researchers led by Min Huang, Merck & Co, conducted a study comparing pembrolizumab and docetaxel in terms of overall survival, QALYs, cost, and cost effectiveness in patients with previously treated NSCLC from a US third-party payer perspective.   

To evaluate the economic implications of the two treatments, researchers estimated incremental cost per QALY gained and incremental cost per life-year using an incremental cost-effectiveness ratio. The model included main efficacy, utility, and safety data and the treatment population was based on the KEYNOTE 010 eligibility criteria, which required patients with advanced NSCLC to be at least 18 years of age and have experienced progression after platinum-containing systemic therapy. The base-case analysis used a time horizon of 20 years, with cost and health outcomes discounted at a rate of 3% per year. 

Base-case results showed a $160,522 difference in the total average per patient cost of treatment with pembrolizumab ($297,443) versus docetaxel ($136,921) over the 20-year time horizon. In addition, the projected survival for patients treated with pembrolizumab was significantly longer than it was for those treated with docetaxel (2.25 years vs 1.07 years), as was expected QALYs gained (1.76 vs .76). Compared with docetaxel, this resulted in an incremental cost per QALY of $168,619/QALY, which is cost effective in the United States. 

“This work includes comprehensive sensitivity analyses that were both deterministic and probabilistic,” the researchers also noted. “In general, sensitivity analyses showed the results to be robust across plausible ranges of inputs, including costs, discount rates, time horizons, utility weights and modeling approaches.”

They concluded that pembrolizumab improves QALYs and is more cost effective than docetaxel for patients with PD-L1-positive NSCLC.

The study was limited by its projections, which were based on short-term data from the KEYNOTE 010 trial and could change with the availability of long-term results. Also, the clinical trial was performed in mostly urban areas, where practices are likely different from general oncology practices in the US.—Sean McGuire 

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Huang M, Lou Y, Pellissier J, et al. Cost-effectiveness of pembrolizumab versus docetaxel for the treatment of previously treated PD-L1 positive advanced NSCLC patients in the United States [published online ahead of print August 29, 2016]. J Med Econ. doi 10.1080/13696998.2016.1230123.