Cost-effectiveness analysis of pembrolizumab plus chemotherapy for patients with recurrent or metastatic cervical cancer in China

Abstract

Objective

To evaluate the cost-effectiveness of adding pembrolizumab to various therapy combinations in patients with recurrent or metastatic cervical cancer from the Chinese perspective.

Materials and methods

The clinical data for our model was taken from the KEYNOTE-826 trial. The direct costs and utilities were collected from local price databases or previously published literature. A three-state partitioned survival model was designed to simulate the disease process of patients with recurrent or metastatic cervical cancer. All costs were estimated in US dollars, with an annual RMB exchange rate of $1 to 6.45 Yuan in 2021. The willingness to pay threshold (WTP) was set at US$37,663.26/QALY. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to evaluate the influence of variables on the model parameters.

Results

For patients with a programmed death-ligand 1 combined positive score greater than 1,compared to the chemotherapy group, pembrolizumab plus chemotherapy contributed an incremental 1.12 Quality-adjusted Life Years (QALYs) with an incremental cost of US$71,884.42, resulting in an incremental cost-effectiveness ratio (ICER) of US$64,338.19, which is beyond the willingness-to-pay (WTP) threshold of China. According to sensitivity analyses, the ICERs were most sensitive to the utility of progressive disease and the cost of pembrolizumab. However, those parameters had no significant impact on the model’s outcomes.

Conclusions

The addition of pembrolizumab to various therapy combinations chemotherapy is exorbitant and may not be cost-effective for patients with recurrent or metastatic cervical cancer in China.

Keywords:

• Cost-effectiveness
• KEYNOTE-826 study
• recurrent or metastatic cervical cancer
• pembrolizumab
• chemotherapy

Transparency

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Data for this study were gathered by ZZ, who also prepared the original draft of the publication. SX carried out research and data curation. The analysis of the economy was done by GQ and XS. HC verified the information and revised the initial draft. All authors took part in the research and gave their approval to the final draft.

Acknowledgements

None.

Ethics statement

Our analysis of cost-effectiveness was based on previously published literature and computer modeling methods. A hospital research ethics board did not need to approve the project.

Additional information

Funding

This work was supported by the Science and Technology Planning Project of Shantou City, China (Grant No. (2022)81–132); The Shantou science and technology plan for health care category project (grant no. 220506106490768).