Cost-effectiveness analysis of pembrolizumab versus chemotherapy for microsatellite instability-high or mismatch repair-deficient metastatic colorectal cancer

Abstract

The aim of this study was to assess the cost-effectiveness of pembrolizumab versus chemotherapy for metastatic colorectal cancer (mCRC) patients with mismatch-repair deficiency or microsatellite instability-high (dMMR/MSI-H) in China. A partitioned survival model was constructed to determine the costs and effects of pembrolizumab and chemotherapy based on KEYNOTE-177 trial outcomes data. Health outcomes were measured in quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). The Chinese health service system perspective was considered. A willing-to-pay threshold was set at 35,832 USD/QALY, which was three times the gross domestic product (GDP) per capita of China in 2021. We examined the robustness of the model in the one-way and probabilistic sensitivity analysis. Pembrolizumab was associated with better health outcomes than chemotherapy (5.30 vs 3.37 QALYs). Compared with chemotherapy, the pembrolizumab strategy yielded an incremental cost of $16 032.57, which resulted in an ICER of $8285 per QALY. The cost of pembrolizumab and chemotherapy had the largest impact on the ICER. The parameters with less influence on the ICER were utility values of the Post-PFS state. Compared to chemotherapy, pembrolizumab had the economic advantage as the first-line treatment of mCRC patients with dMMR/MSI-H in China.

Keywords:

• Pembrolizumab
• chemotherapy
• colorectal cancer
• mismatch-repair deficiency
• cost-effectiveness

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics approval

Ethical approval was waived by the local Ethics Committee of Harbin Medical University Cancer Hospital because of the retrospective nature of the study and all the procedures being performed were part of the routine care. Consent to publish: The participants have consented to the submission of the report to the journal.

Data availability statement

All data generated or analyzed during this study are included in this published article.

Author contributions

Tong Liu: drafting the manuscript. Shuang Liu: data acquisitions. Shangwei Guan, Yu Tai, and Yao Jin: data analysis. Mei Dong: design of this study.

Additional information

Funding

This study was supported by the Haiyan Foundation of Harbin Medical University Cancer Hospital (JJQN2023-09).