Cost-Effectiveness of Pembrolizumab in Combination with Platinum-Based Chemotherapy in First-Line for Squamous and Nonsquamous Non Small-Cell Lung Cancer. Far from Economic Sustainability

Abstract

DOI: 10.14744/ejmo.2021.96518 EJMO 2021;5(1):59–62 Cite This Article: Giuliani J, Bonetti A. Cost-Effectiveness of Pembrolizumab in Combination with Platinum-Based Chemotherapy in First-Line for Squamous and Nonsquamous Non Small-Cell Lung Cancer. Far from Economic Sustainability. EJMO 2021;5(1):59–62. Research Article 60 Giuliani et al., A Perspective Based on Pharmacological Costs / doi: 10.14744/ejmo.2021.96518 ent analysis was conducted to assess the pharmacological costs of pembrolizumab in association with platinumbased chemotherapy as first-line treatment in squamous and nonsquamous NSCLC. Materials and Methods Pivotal phase III randomized controlled trials (RCTs) were considered.[2,3] Differences in PFS (expressed in months) between the different arms were calculated and compared with the pharmacological costs needed to get one month of PFS. Combining the costs of therapy with the measure of efficacy represented by the PFS, we get the costs for obtaining the advantage in PFS, for each arm of the analyzed trials. Incremental cost-effectiveness ratio (ICER) was calculated as the ratio between the difference of the costs in the intervention and in the control groups (pharmacy costs) and the difference between the effect in the intervention and in the control groups (PFS). The costs of drugs are at the Pharmacy of our Hospital (Italy) and are expressed in euros (€), updated to September 2020. Calculations were based on an “ideal patient” (BSA 1.8 sqm; weight 70 Kg). The dosage of drugs were considered according to those reported in the pivotal phase III RCT2. For pembrolizumab we assumed the following pharmacy cost: 2056.08 € for 100 mg vial. All data were reviewed by 2 investigators (J.G., A.B.) and separately computed by 2 investigators (J.G., A.B.). We have subsequently applied the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS) to the above RCTs,[4] to derive a relative ranking (from grade 1 to grade 5) of the magnitude of clinically meaningful benefit that can be expected in this setting [5]; adjustments (upgrade or down-grade) are planned based on quality of life (QoL) or grade 3-4 toxicities impacting daily well-being.