ORIGINAL RESEARCH article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1665469
Pharmacoeconomic evaluation of weight-based vs fixed-dose pembrolizumab for non-small cell lung cancer in China
Provisionally accepted
- Second Xiangya Hospital, Central South University, Changsha, China
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Background: While the immune checkpoint inhibitor pembrolizumab has improved outcomes for non-small cell lung cancer (NSCLC), the leading cause of cancer death in China, its standard fixed-dose regimen is costly. Given that studies demonstrate comparable efficacy between fixed and weight-based dosing, we aimed to compare the economic impact of these two dosing regimens in China. Methods: We conducted a one-year budget impact analysis from the Chinese payer perspective comparing fixed-dose (200 mg Q3W) versus weight-based (2 mg/kg Q3W) pembrolizumab regimens. Model parameters, including lung cancer epidemiology, treatment costs and market penetration rates, were derived from published studies and open-access databases. Scenarios with and without institutional vial dose-sharing were analyzed, and comprehensive one-way and probabilistic sensitivity analyses (PSA) were performed to assess model robustness. Results: The standard fixed-dose regimen was projected to have an annual cost of $6.67 billion. In a dose-sharing scenario, the weight-based regimen reduced annual drug consumption by 34.41%, resulting in a total saving of $2.29 billion. This lowered the annual cost per patient from $86,392 to $56,661. Without dose-sharing, the weight-based regimen still yielded an annual saving of $76.93 million. PSA confirmed the robustness of these findings, showing a 50% probability of achieving savings greater than $2.09 billion in the dose-sharing scenario. Conclusion: Adopting a weight-based dosing strategy for pembrolizumab, especially when optimized with vial-sharing protocols, offers substantial and achievable annual cost savings for the Chinese healthcare system without compromising therapeutic efficacy. Therefore, this regimen should be considered as a potential first-line treatment option for patients with advanced NSCLC.
Keywords: Pembrolizumab, Pharmacoeconomics, Weight-based dosing, Non-small cell lung cancer, China
Received: 14 Jul 2025; Accepted: 26 Sep 2025.
Copyright: © 2025 Wu, Yi, Li, Meng, Zhang, Shi, Tan, Wan and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jinan Ma, majinancs@csu.edu.cn
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