Table 4.
Cost-effectiveness evidence with pembrolizumab in patients with breast and gynecologic cancers
| Indication | Trial name | Country | Treatments | QALY gain | Incremental cost | ICER (per QALY) | WTP threshold (per QALY) |
|---|---|---|---|---|---|---|---|
| TNBC | KEYNOTE-522 [95] | USA | Pembrolizumab + chemotherapy (neoadjuvant) followed by pembrolizumab (adjuvant) vs placebo + chemotherapy (neoadjuvant) followed by placebo (adjuvant) | 2.90 | $79,046 | $27,285 | Up to $200,000 |
| TNBC | KEYNOTE-355 [96] | USA |
Pembrolizumab + chemotherapy vs placebo + chemotherapy Pembrolizumab + nab-paclitaxel (data from KEYNOTE-355) vs atezolizumab + nab-paclitaxel (data from IMpassion130) |
0.70a 0.61a |
$127,706a $26,867a |
$183,732a $44,157a |
Up to $200,000 |
| Endometrial cancer | KEYNOTE-158 and literature review [97] | USA | Pembrolizumab (data from KEYNOTE-158) vs chemotherapy (data from published literature; MSI-H/dMMR status unknown) | 3.80 | $220,934 | $58,165 | Up to $200,000 |
| Endometrial cancer | NRG-GY018 [98] | USA | Pembrolizumab + carboplatin and paclitaxel vs chemotherapy |
dMMR: 4.05 pMMR: 0.93 |
dMMR: $167,224 pMMR: $83,661 |
dMMR: $41,305.09 pMMR: $90,284.80 |
Up to $150,000 |
| Endometrial cancer | Study 309-KEYNOTE-775 [99] | USA | Lenvatinib + pembrolizumab vs chemotherapy | – | – | $163,735 | – |
| Cervical cancer | KEYNOTE-826 [100] | USA | Pembrolizumab + chemotherapy vs placebo + chemotherapy | 1.42 | $203,700 | $142,996 | Up to $200,000 |
CPS combined positive score, ICER incremental cost-effectiveness ratio, PD-L1 programmed cell death ligand 1, QALY quality-adjusted life years, TNBC triple-negative breast cancer, WTP willingness to pay
aData reported for PD-L1 CPS ≥ 10 population