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Cost Effectiveness of PD-L1-Based Test-and-Treat Strategy with Pembrolizumab as the First-Line Treatment for Metastatic NSCLC in Hong Kong

Author

Listed:
  • Herbert H. Loong

    (The Chinese University of Hong Kong)

  • Carlos K. H. Wong

    (The University of Hong Kong)

  • Linda Kam Suet Leung

    (The Chinese University of Hong Kong)

  • Praveen Dhankhar

    (Complete HEOR Solutions LLC)

  • Ralph P. Insinga

    () (Merck Sharp and Dohme Corp, Center for Observational and Real-World Evidence)

  • Sheenu Chandwani

    (Merck Sharp and Dohme Corp, Center for Observational and Real-World Evidence)

  • Danny C. Hsu

    (Merck Sharp & Dohme (Asia) Ltd)

  • Mary Y. K. Lee

    (Merck Sharp & Dohme (Asia) Ltd)

  • Min Huang

    (Merck Sharp and Dohme Corp, Center for Observational and Real-World Evidence)

  • James Pellissier

    (Merck Sharp and Dohme Corp, Center for Observational and Real-World Evidence)

  • Akanksha Rai

    (Complete HEOR Solutions LLC)

  • Monika Achra

    (Complete HEOR Solutions LLC)

  • Seng Chuen Tan

    (Merck Sharp & Dohme (Asia Pacific))

Abstract

Background Pembrolizumab, a monoclonal antibody against programmed death ligand 1 (PD-L1), is approved by several regulatory agencies for first-line treatment of metastatic non-small-cell lung cancer (NSCLC) with a PD-L1 tumor proportion score (TPS) ≥ 50% and no epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase genomic tumor aberrations. This study was conducted from the perspective of the Hospital Authority in Hong Kong and aimed to evaluate the cost effectiveness of a biomarker (PD-L1) test-and-treat strategy (BTS), in which patients with a TPS ≥ 50% received pembrolizumab and other patients received platinum doublet chemotherapy versus all patients receiving platinum doublet chemotherapy. Methods The model used a partitioned survival approach to estimate the incremental cost-effectiveness ratio (ICER) expressed as the cost per quality-adjusted life-year (QALY) gained. The clinical efficacy, utility and safety data were derived from the KN024 trial. Costs and health outcomes were projected over a 10-year time horizon and discounted at 3% per year. Costs for drug acquisition, PD-L1 testing, drug administration and disease management were used. Sensitivity analyses were conducted to evaluate the robustness of results. Results The BTS approach led to an increase of 0.29 QALYs at an additional cost of Hong Kong dollars (HK$) 249,077 (US$31,933) compared with platinum doublet chemotherapy, resulting in an ICER of HK$865,189 (US$110,922) per QALY gained. This is lower than the World Health Organization cost-effectiveness threshold of three times the 2016 gross domestic product (GDP) per capita for Hong Kong of HK$1017,819 (US$130,490). Probabilistic sensitivity analyses showed a 59.4% chance that the ICER would be below this threshold. Conclusion First-line treatment with pembrolizumab in a BTS to identify patients with NSCLC with PD-L1 TPS ≥ 50% can be considered cost effective in Hong Kong compared with platinum doublet chemotherapy based on a three-times GDP per capita threshold. However, local data on clinical efficacy and safety were not available to estimate overall survival (OS) and progression-free survival (PFS) specific to patients with NSCLC in Hong Kong. Further, uncertainty is inherent in the survival projections/extrapolation of PFS and OS beyond the trial period, and future research may help to further inform these parameters.

Suggested Citation

  • Herbert H. Loong & Carlos K. H. Wong & Linda Kam Suet Leung & Praveen Dhankhar & Ralph P. Insinga & Sheenu Chandwani & Danny C. Hsu & Mary Y. K. Lee & Min Huang & James Pellissier & Akanksha Rai & Mon, 2020. "Cost Effectiveness of PD-L1-Based Test-and-Treat Strategy with Pembrolizumab as the First-Line Treatment for Metastatic NSCLC in Hong Kong," PharmacoEconomics - Open, Springer, vol. 4(2), pages 235-247, June.
  • Handle: RePEc:spr:pharmo:v:4:y:2020:i:2:d:10.1007_s41669-019-00178-7
    DOI: 10.1007/s41669-019-00178-7
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Chris Sampson’s journal round-up for 1st June 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-06-01 11:00:00

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