Pembrolizumab Plus Chemotherapy For Small-Cell Lung Cancer:A Cost-Effectiveness Analysis

Objective:We aim to evaluate the cost-effectiveness of pembrolizumab plus chemotherapy as the first-line treatment of Extensive-Stage Small-Cell Lung Cancer(ES-SCLC)from the United States(US)payers’ perspective.Methods:A synthetical Markov model was used to evaluate cost and effectiveness of pembrolizumab plus platinum-etoposide(EP)versus EP in first-line therapy for ES-SCLC from the data of Keynote-604.Lifetime costs life-years(LYs),quality adjusted LYs(QALYs),and incremental cost-effectiveness ratios(ICERs)were estimated.One-way and probabilistic sensitivity analyses were performed.In addition,We also considered subgroup cost-effectiveness.Results:Pembrolizumab plus EP resulted in additional 0.18 QALYs(0.32LYs)and corresponding incremental costs $113,625,resulting an ICER of $647,509/QALY versus EP.The most influential factor in this model was the cost of pembrolizumab.Probabilistic sensitivity analysis showed there was 0% probability that pembrolizumab combination chemotherapy was cost-effective at willingness-to-pay(WTP)values of $150,000/QALY in the US.The results of subgroup probabilistic sensitivity analyses suggested that all subgroups were not cost-effective.Conclusion:First-line Pembrolizumab in combination with EP in ES-SCLC patients is not cost-effective at traditional WTP values in the US.