AUTHOR=Zheng Zhiwei , Lin Jingrong , Zhu Huide , Cai Hongfu 

TITLE=Cost-Effectiveness Analysis of Pembrolizumab Plus Chemotherapy vs. Chemotherapy Alone as First-Line Treatment in Patients With Esophageal Squamous Cell Carcinoma and PD-L1 CPS of 10 or More

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.893387

DOI=10.3389/fpubh.2022.893387

ISSN=2296-2565

ABSTRACT=Background: This study was aimed to analyze the economics of pembrolizumab plus chemotherapy as first-line treatment in patients with esophageal squamous cell carcinoma(ESCC) and PD-L1 CPS of 10 or more in China
Methods: Basis on the advanced ESCC of the KEYNOTE-590 clinical trial data, a Markov model was performed to simulate the clinical course and evaluate the patient’s total lifetime, total costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER) for pembrolizumab plus chemotherapy (cisplatin and 5-fluorouracil) versus chemotherapy alone in first-line treatment of ESCC and PD-L1 CPS of 10 or more. Utility values and direct costs related to the treatments were gathered from the published literature data. One-way and probability sensitivity analyses were conducted to check the stability in the model.
Results: The baseline analysis indicated that the incremental effectiveness and cost of pembrolizumab plus chemotherapy versus chemotherapy alone added 1.23 QALYs  and resulted in an incremental cost of $51320.22,which had an ICER of $41805.12/QALY, higher than the willingness-to-pay (WTP) threshold of China ($31,498.70/QALY). Sensitivity analysis demonstrated that the ICERs were most sensitive to the cycle of pembrolizumab used and the cost of pembrolizumab.
Conclusion: The result of our present analysis suggested that addition of pembrolizumab plus chemotherapy as first-line treatment might not be cost-effective for patients with ESCC and PD-L1 CPS of 10 or more in China.