Combination of pembrolizumab and chemotherapy as first-line treatment in advanced triple-negative breast cancer: a cost-effectiveness analysis

doi:10.5246/jcps.2023.07.049

Abstract

Abstract:

The purpose of this study was to assess the cost-effectiveness of using pembrolizumab plus chemotherapy for advanced triple-negative breast cancer (TNBC) in the context of China’s healthcare system. To achieve this, we developed a Markov model with three health states, a time horizon of 10 years, and a cycle length of 21 days. Additionally, we conducted one-way sensitivity analyses and probabilistic sensitivity analyses to test the model’s stability. Scenario analyses were also performed to explore the cost-effectiveness of pembrolizumab plus chemotherapy based on the Patient Assistance Program (PAP). The base-case analysis demonstrated that pembrolizumab plus chemotherapy provided an additional 0.67 QALYs, with an incremental cost of \$ 77 096.78, resulting in an ICER of \$ 115 896.30/QALY. One-way sensitivity analyses revealed that pembrolizumab cost had the greatest impact on the results. In probabilistic sensitivity analyses, pembrolizumab plus chemotherapy was found to be cost-effective in 0% of cases at willingness-to-pay thresholds of \$ 33 782.23/QALY. Considering China’s healthcare system, pembrolizumab plus chemotherapy as first-line treatment for advanced TNBC was unlikely to be cost-effective when compared to placebo plus chemotherapy. Even if pembrolizumab was to be included in the PAP, it would still not be considered cost-effective, although the ICER would be much closer to three times China’s GDP per capita (\$ 33 782.23/QALY).

Key words: Cost-effectiveness, Pembrolizumab, Chemotherapy, Advanced triple-negative breast cancer, Markov model

Supporting:

Wentao Zhu, Wanglong Hong, Miaomiao Zheng, Guoqiang Ma, Aizong Shen. Combination of pembrolizumab and chemotherapy as first-line treatment in advanced triple-negative breast cancer: a cost-effectiveness analysis[J]. Journal of Chinese Pharmaceutical Sciences, 2023, 32(7): 587-597.

Figures/Tables 11

Table 1. The optimal fitting distribution and parameters of the survival curve.

Table 2. Comparison of the incidence of AEs (grade ≥ 3).

Table 3. Key model parameters.

Table 4. Basic analysis results.

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