Cost-effectiveness Analysis of Pembrolizumab Versus Chemotherapy as First-line Treatment in Non-small Cell Lung Cancer in China Based on Markov Model

OBJECTIVE To evaluate the economics of pembrolizumab monotherapy and chemotherapy in the first-line treatment with different PD-L1 tumor proportion scores(TPS) ≥ 1% in locally advanced or metastatic non-small cell lung cancer from the perspective of health system and to provide a basis for health decisions. METHODS According to the disease development process, a three-state Markov model:progression-free, progressive disease and death was established, and the quality-adjusted life year(QALY) was used as the output to calculate the incremental cost-effectiveness ratio. Survival analysis data came from a multi-center randomized, open-label, phase Ⅲ clinical trial KEYNOTE-042. Cost data came from the Minei website and median of eight provinces health care service prices. Utility data came from published literature. Sensitivity analysis and scenario analysis were also performed. RESULTS Based on the results of the basic analysis, compared to the standard chemotherapy group, the incremental cost-effectiveness ratio of pembrolizumab monotherapy was 395 332.25 yuan/QALY(TPS ≥ 50%), 735 613.67 yuan/QALY(TPS ≥ 20%) and 597 770.09 yuan/QALY(TPS ≥ 1%) in people with different PD-L1 TPS. The deterministic sensitivity analysis showed that the price of pembrolizumab and the utility of PFS had a greater impact on the changes in ICER. The results of probability sensitivity analysis showed that the model structure was stable and robust. CONCLUSION Under the willingness to pay threshold of three times per capita GDP of China(212 676.00 yuan), pembrolizumab monotherapy does not cost-effectiveness compared with chemotherapy, and its economic can be achieved by reducing prices in the future.