IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0258605.html
   My bibliography  Save this article

Cost-effectiveness analysis of pembrolizumab plus chemotherapy as first-line therapy for extensive-stage small-cell lung cancer

Author

Listed:
  • Qiao Liu
  • Chongqing Tan
  • Lidan Yi
  • Xiaomin Wan
  • Liubao Peng
  • Jianhe Li
  • Xia Luo
  • Xiaohui Zeng

Abstract

Background: The phase III KEYNOTE-604 study confirmed the benefit of pembrolizumab combined with chemotherapy in the first-line treatment of extensive-stage small-cell lung cancer (ES-SCLC). Taken into account the clinical benefits of pembrolizumab and its high cost, this study aimed to assess the cost-effectiveness of adding pembrolizumab to standard first-line etoposide-platinum (EP) for patients with ES-SCLC from the US payer perspective. Methods: A Markov model was developed to compare the cost and quality-adjusted life-year (QALY) of pembrolizumab plus EP and placebo plus EP over a 10-year time horizon. Clinical efficacy and safety data were pooled from the KEYNOTE-604 trial. Utilities were obtained from published resources. Costs were mainly collected from Medicare in 2020. Sensitivity analyses were performed to examine the robustness of our model. Results: Adding pembrolizumab to standard first-line EP resulted in the better effectiveness than EP chemotherapy alone for ES-SCLC by 0.22 QALYs. Pembrolizumab plus EP was dominated economically by placebo plus EP, leading to an incremental cost-effectiveness ratio (ICER) of $334,373/ QALY. Deterministic sensitivity analyses indicated that the uncertainty in model parameters exerted no substantial effect on our results. Probability sensitivity analysis indicated that probabilities for pembrolizumab plus EP being cost-effective within a wide range of willingness to pay were modest. Conclusion: From the US payer perspective, the first-line treatment for ES-SCLC with pembrolizumab plus EP was not cost-effective compared with placebo plus EP. Although pembrolizumab combination chemotherapy was beneficial to the survival of ES-SCLC, price reduction may be the necessary to improve its cost-effectiveness.

Suggested Citation

  • Qiao Liu & Chongqing Tan & Lidan Yi & Xiaomin Wan & Liubao Peng & Jianhe Li & Xia Luo & Xiaohui Zeng, 2021. "Cost-effectiveness analysis of pembrolizumab plus chemotherapy as first-line therapy for extensive-stage small-cell lung cancer," PLOS ONE, Public Library of Science, vol. 16(11), pages 1-13, November.
    • Handle: RePEc:plo:pone00:0258605
    DOI: 10.1371/journal.pone.0258605
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258605
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0258605&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0258605?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Andrew H. Briggs & Milton C. Weinstein & Elisabeth A. L. Fenwick & Jonathan Karnon & Mark J. Sculpher & A. David Paltiel, 2012. "Model Parameter Estimation and Uncertainty Analysis," Medical Decision Making, , vol. 32(5), pages 722-732, September.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Dimitris Bertsimas & John Silberholz & Thomas Trikalinos, 2018. "Optimal healthcare decision making under multiple mathematical models: application in prostate cancer screening," Health Care Management Science, Springer, vol. 21(1), pages 105-118, March.
    2. Ava A John-Baptiste & Wei Wu & Paula Rochon & Geoffrey M Anderson & Chaim M Bell, 2013. "A Systematic Review and Methodological Evaluation of Published Cost-Effectiveness Analyses of Aromatase Inhibitors versus Tamoxifen in Early Stage Breast Cancer," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-9, May.
    3. Ezbakhe, Fatine & Pérez-Foguet, Agustí, 2021. "Decision analysis for sustainable development: The case of renewable energy planning under uncertainty," European Journal of Operational Research, Elsevier, vol. 291(2), pages 601-613.
    4. Samir S Soneji & Hai-Yen Sung & Brian A Primack & John P Pierce & James D Sargent, 2018. "Quantifying population-level health benefits and harms of e-cigarette use in the United States," PLOS ONE, Public Library of Science, vol. 13(3), pages 1-19, March.
    5. Elisa Sicuri & Silke Fernandes & Eusebio Macete & Raquel González & Ghyslain Mombo-Ngoma & Achille Massougbodgi & Salim Abdulla & August Kuwawenaruwa & Abraham Katana & Meghna Desai & Michel Cot & Mic, 2015. "Economic Evaluation of an Alternative Drug to Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy," PLOS ONE, Public Library of Science, vol. 10(4), pages 1-23, April.
    6. Jing Voon Chen & Julia L. Higle & Michael Hintlian, 2018. "A systematic approach for examining the impact of calibration uncertainty in disease modeling," Computational Management Science, Springer, vol. 15(3), pages 541-561, October.
    7. Naveed Chehrazi & Lauren E. Cipriano & Eva A. Enns, 2019. "Dynamics of Drug Resistance: Optimal Control of an Infectious Disease," Operations Research, INFORMS, vol. 67(3), pages 619-650, May.
    8. Rowan Iskandar & Carlo Federici & Cassandra Berns & Carl Rudolf Blankart, 2022. "An approach to quantify parameter uncertainty in early assessment of novel health technologies," Health Economics, John Wiley & Sons, Ltd., vol. 31(S1), pages 116-134, September.
    9. Bogumił Kamiński & Michał Jakubczyk & Przemysław Szufel, 2018. "A framework for sensitivity analysis of decision trees," Central European Journal of Operations Research, Springer;Slovak Society for Operations Research;Hungarian Operational Research Society;Czech Society for Operations Research;Österr. Gesellschaft für Operations Research (ÖGOR);Slovenian Society Informatika - Section for Operational Research;Croatian Operational Research Society, vol. 26(1), pages 135-159, March.
    10. Jennifer A Gilbert & Sheela V Shenoi & Anthony P Moll & Gerald H Friedland & A David Paltiel & Alison P Galvani, 2016. "Cost-Effectiveness of Community-Based TB/HIV Screening and Linkage to Care in Rural South Africa," PLOS ONE, Public Library of Science, vol. 11(12), pages 1-19, December.
    11. Brown, Vicki & Diomedi, Belen Zapata & Moodie, Marj & Veerman, J. Lennert & Carter, Rob, 2016. "A systematic review of economic analyses of active transport interventions that include physical activity benefits," Transport Policy, Elsevier, vol. 45(C), pages 190-208.
    12. Johanna Leväsluoto & Johanna Kohl & Anton Sigfrids & Jussi Pihlajamäki & Janne Martikainen, 2021. "Digitalization as an Engine for Change? Building a Vision Pathway towards a Sustainable Health Care System by Using the MLP and Health Economic Decision Modelling," Sustainability, MDPI, vol. 13(23), pages 1-24, November.
    13. Jonathan D. Campbell & R. Brett McQueen & Anne M. Libby & D. Eldon Spackman & Joshua J. Carlson & Andrew Briggs, 2015. "Cost-Effectiveness Uncertainty Analysis Methods," Medical Decision Making, , vol. 35(5), pages 596-607, July.
    14. Bromley, Hannah L. & Petrie, Dennis & Mann, G.Bruce & Nickson, Carolyn & Rea, Daniel & Roberts, Tracy E., 2019. "Valuing the health states associated with breast cancer screening programmes: A systematic review of economic measures," Social Science & Medicine, Elsevier, vol. 228(C), pages 142-154.
    15. Boshen Jiao & Yuli Lily Hsieh & Meng Li & Stéphane Verguet, 2025. "Value‐Based Pricing for Drugs With Uncertain Clinical Benefits," Health Economics, John Wiley & Sons, Ltd., vol. 34(4), pages 780-790, April.
    16. Amin Mahmoudi & Saad Ahmed Javed, 2023. "Uncertainty Analysis in Group Decisions through Interval Ordinal Priority Approach," Group Decision and Negotiation, Springer, vol. 32(4), pages 807-833, August.
    17. Yazdan Yazdanpanah & Julian Perelman & Madeline A DiLorenzo & Joana Alves & Henrique Barros & Céu Mateus & João Pereira & Kamal Mansinho & Marion Robine & Ji-Eun Park & Eric L Ross & Elena Losina & Ro, 2013. "Routine HIV Screening in Portugal: Clinical Impact and Cost-Effectiveness," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-1, December.
    18. David Epstein & Leticia García-Mochón & Stephen Kaptoge & Simon G. Thompson, 2016. "Modeling the costs and long-term health benefits of screening the general population for risks of cardiovascular disease: a review of methods used in the literature," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(8), pages 1041-1053, November.
    19. Joseph F. Levy & Patrick D. Meek & Marjorie A. Rosenberg, 2015. "US-Based Drug Cost Parameter Estimation for Economic Evaluations," Medical Decision Making, , vol. 35(5), pages 622-632, July.
    20. Sung Eun Choi & Lisa Simon & Jane R. Barrow & Nathan Palmer & Sanjay Basu & Russell S. Phillips, 2020. "Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices," IJERPH, MDPI, vol. 17(6), pages 1-13, March.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0258605. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.