ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Pharmacoepidemiology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1654177
Cost-effectiveness analysis of pembrolizumab plus chemotherapy versus placebo plus chemotherapy for patients with previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer in China
Provisionally accepted
- 1Second Hospital of Hebei Medical University, Shijiazhuang, China
- 2Hebei Medical University, Shijiazhuang, China
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Abstract: Background: The present study aimed to evaluate the cost-effectiveness of pembrolizumab combined with chemotherapy versus placebo plus chemotherapy for patients with previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer from the perspective of the Chinese healthcare system. Methods: A Markov model was developed to track patients' transitions over 3-week cycles and evaluate the health and economic outcomes over a 10-year horizon for the two competing treatments. The survival data were gathered from the KEYNOTE-355 trial, and cost and utility values were obtained from the published studies. Total costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) were the model outcomes. We conducted analysis based on patients’ programmed death-ligand 1 (PD-L1) combined positive score (CPS), including subgroups with CPS≥10, CPS≥1, and the intention-to-treat population. One-way sensitivity analysis, probabilistic sensitivity analysis and scenario analysis were performed to examine the robustness of the model results. Results: In the base case analysis for patients highly expressing PD-L1 (CPS≥10), pembrolizumab plus chemotherapy yielded a marginal cost of $85,838.75 and an additional 0.47 QALYs, resulting in an ICER of $184,030.56 per additional QALY gained, which exceeded the willingness-to-pay (WTP) threshold of $38,224 per QALY in China. And the ICERs were $319,506.90/QALY for patients lowly expressing PD-L1 (CPS≥1) and $776,786.75/QALY for the intention-to-treat population. Sensitivity analyses confirmed the robustness of the model outcomes. Scenario analysis demonstrated that price reductions for pembrolizumab could enhance its likelihood of achieving cost-effectiveness. Conclusion: The findings of this cost-effectiveness analysis suggest that pembrolizumab plus chemotherapy was not a cost-effective treatment for patients with previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer in China.
Keywords: Triple-negative breast cancer, Cost-Effectiveness, Pembrolizumab, placebo, Markov model
Received: 26 Jun 2025; Accepted: 05 Aug 2025.
Copyright: © 2025 Hou, Yang, Wang, Zhao, Liu and Kang. 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:
Huanlong Liu, Second Hospital of Hebei Medical University, Shijiazhuang, China
Shuo Kang, Second Hospital of Hebei Medical University, Shijiazhuang, China
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