title: Cost-effectiveness of pembrolizumab versus docetaxel for the treatment of previously treated PD-L1 positive advanced NSCLC patients in the United States.
abstract: OBJECTIVE
  This analysis aimed to evaluate the cost-effectiveness of pembrolizumab compared with docetaxel in patients with previously treated advanced non-squamous cell lung cancer (NSCLC) with PD-L1 positive tumors (total proportion score [TPS] ≥ 50%). The analysis was conducted from a US third-party payer perspective.
  
  
  METHODS
  A partitioned-survival model was developed using data from patients from the KEYNOTE 010 clinical trial. The model used Kaplan-Meier (KM) estimates of progression-free survival (PFS) and overall survival (OS) from the trial for patients treated with either pembrolizumab 2 mg/kg or docetaxel 75 mg/m2with extrapolation based on fitted parametric functions and long-term registry data. Quality-adjusted life years (QALYs) were derived based on EQ-5D data from KEYNOTE 010 using a time to death approach. Costs of drug acquisition/administration, adverse event management, and clinical management of advanced NSCLC were included in the model. The base-case analysis used a time horizon of 20 years. Costs and health outcomes were discounted at a rate of 3% per year. A series of one-way and probabilistic sensitivity analyses were performed to test the robustness of the results.
  
  
  RESULTS
  Base case results project for PD-L1 positive (TPS ≥50%) patients treated with pembrolizumab a mean survival of 2.25 years. For docetaxel, a mean survival time of 1.07 years was estimated. Expected QALYs were 1.71 and 0.76 for pembrolizumab and docetaxel, respectively. The incremental cost per QALY gained with pembrolizumab vs docetaxel is $168,619/QALY, which is cost-effective in the US using a threshold of 3-times GDP per capita. Sensitivity analyses showed the results to be robust over plausible values of the majority of inputs. Results were most sensitive to extrapolation of overall survival.
  
  
  CONCLUSIONS
  Pembrolizumab improves survival, increases QALYs, and can be considered as a cost-effective option compared to docetaxel in PD-L1 positive (TPS ≥50%) pre-treated advanced NSCLC patients in the US.
authors: a Centre for Observational and Real-world Evidence , Merck & Co., Inc. , North Wales , PA , USA.
authors: Min
authors: M
authors: Huang
authors: b Department of Hematology and Oncology , Mayo Clinic , Jacksonville , FL , USA.
authors: Yanyan
authors: Y
authors: Lou
authors: a Centre for Observational and Real-world Evidence , Merck & Co., Inc. , North Wales , PA , USA.
authors: James
authors: J
authors: Pellissier
authors: a Centre for Observational and Real-world Evidence , Merck & Co., Inc. , North Wales , PA , USA.
authors: Thomas
authors: T
authors: Burke
authors: a Centre for Observational and Real-world Evidence , Merck & Co., Inc. , North Wales , PA , USA.
authors: Frank Xiaoqing
authors: FX
authors: Liu
authors: a Centre for Observational and Real-world Evidence , Merck & Co., Inc. , North Wales , PA , USA.
authors: Ruifeng
authors: R
authors: Xu
authors: c Solid Tumor Oncology , Cleveland Clinic , Cleveland , OH , USA.
authors: Vamsidhar
authors: V
authors: Velcheti
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000191:economics*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000191:economics*; D060890:B7-H1 Antigen; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003362:Cost-Benefit Analysis / Q000379:methods*; D000077143:Docetaxel; D006801:Humans; D008962:Models, Theoretical; D012042:Registries; D011795:Surveys and Questionnaires; D043823:Taxoids / Q000008:administration & dosage / Q000191:economics*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D060890:B7-H1 Antigen; C423236:CD274 protein, human; D043823:Taxoids; D000077143:Docetaxel; C582435:pembrolizumab
keywords: Advanced NSCLC; Cost-effectiveness; Docetaxel; PD-L1 positive; Pembrolizumab