Cost-Effectiveness of Pembrolizumab in Combination withPlatinum-Based Chemotherapy in First-Line for Squamousand Nonsquamous Non Small-Cell Lung Cancer. Far from Economic Sustainability

Abstract

Objectives: To assess the pharmacological costs of pembrolizumab in association with chemotherapy as first-linetreatment 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 onemonth of PFS (incremental cost-effectiveness ratio, ICER).Results: One thousand one hundred and seventy five patients were included.Differences in costs between the 2 armswith the use of pembrolizumab were 37 009 € for squamous NSCLC and 45 234 € for nonsquamous NSCLC, with a costof 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 €) toPD-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 forboth squamous and nonsquamous NSCLC. A reduction in pharmacy cost is mandatory