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. 2021 May;38(5):2613-2630.
doi: 10.1007/s12325-021-01656-3. Epub 2021 Apr 15.

Cost-Effectiveness of Pembrolizumab Regimens for the First-Line Treatment of Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma in Argentina

Victoria Wurcel  1 , Diana Chirovsky  2 , Rebekah Borse  2 , Juan Ignacio Altuna  3 , Fernando Carabajal  3 , Jyotika Gandhi  4
Affiliations

Cost-Effectiveness of Pembrolizumab Regimens for the First-Line Treatment of Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma in Argentina

Victoria Wurcel et al. Adv Ther. 2021 May.

Abstract

Introduction: The phase III KEYNOTE-048 trial showed that the programmed death receptor 1 (PD-1) inhibitor pembrolizumab, in the combined positive score (CPS) ≥ 1 population and combined with platinum + 5-fluorouracil in the total population, improves survival over cetuximab + platinum + 5-fluorouracil in recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC). We evaluated the cost-effectiveness of pembrolizumab as monotherapy in the CPS ≥ 1 population or combined with platinum + 5-fluorouracil in the total population versus cetuximab + platinum + 5-fluorouracil from the social security perspective in Argentina.

Methods: A partitioned survival model projected costs and outcomes over 20 years with 3% annual discounting. Health state occupancy was modeled using KEYNOTE-048 Kaplan-Meier curves until the final analysis data cutoff, followed by parametric extrapolations guided by statistical criteria. Costs for initial and subsequent treatments, disease and adverse events management, and terminal care were included (AR $74.00 = 1 USD). Time-on-treatment and EuroQol five-dimension scores were taken from KEYNOTE-048. Utilities were derived using an Argentina-specific algorithm.

Results: With pembrolizumab monotherapy, patients accrued 1.1040 additional life-years and 0.8768 additional quality-adjusted life-years (QALYs), for incremental cost-effectiveness ratios (ICERs) of AR $135,801/life-year and AR $170,985/QALY gained over cetuximab + platinum + 5-fluorouracil. Additional life-years and QALYs gained with pembrolizumab combination therapy versus cetuximab + platinum + 5-fluorouracil were 1.3296 and 1.0536, respectively (ICERs of AR $680,143/life-year and AR $858,306/QALY). Considering a threshold of AR $1,676,122/QALY gained, pembrolizumab monotherapy and combination therapy had an 88.0% and a 77.1% probability of being cost-effective, respectively.

Conclusion: Pembrolizumab either as monotherapy or in combination with chemotherapy offers substantial survival gains for patients with R/M HNSCC at small additional costs, making it a cost-effective treatment versus cetuximab + platinum + 5-FU in Argentina.

Keywords: Argentina; Cetuximab; Cost-effectiveness; Head and neck squamous cell carcinoma; Latin America; Pembrolizumab.

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Figures

Fig. 1
Fig. 1
Model schematic
Fig. 2
Fig. 2
Predicted long-term outcomes under base-case parametric distribution assumptions. CPS combined positive score, OS overall survival, PFS progression-free survival, 5-FU 5-fluorouracil. AR $74 = 1 USD = 0.84 euro
Fig. 3
Fig. 3
Tornado diagram showing the variation in ICER value based upon one-way deterministic parameters changes and scenarios. a Pembrolizumab monotherapy versus Cetuximab + Platinum + 5-FU in patient with CPS ≥ 1 and b Pembrolizumab combination therapy versus Cetuximab + Platinum + 5-FU in the total population. CPS combined positive score, GG generalized gamma, mg milligram, m meter, OS overall survival, Pembro pembrolizumab, PFS progression-free survival, QALY quality-adjusted life-year, 1L first line, 5-FU 5-fluorouracil. AR $74 = 1 USD = 0.84 euro
Fig. 4
Fig. 4
Cost-effectiveness plane for pembrolizumab regimens compared to cetuximab + platinum + 5-fluorouacil. CPS combined positive score, ICER incremental cost-effectiveness ratio, QALY quality-adjusted life-year. AR $74 = 1 USD = 0.84 euro
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