Cost-effectiveness analysis of pembrolizumab compared to standard of care as first line treatment for patients with advanced melanoma in Hong Kong

Herbert H Loong; Carlos K H Wong; Linda K S Leung; S C Tan; Jason Jen; Mary Y K Lee; Raquel Aguiar-Ibáñez; Jingshu Wang

doi:10.1186/s12962-020-0200-9

Cost-effectiveness analysis of pembrolizumab compared to standard of care as first line treatment for patients with advanced melanoma in Hong Kong

Cost Eff Resour Alloc. 2020 Jan 15:18:2. doi: 10.1186/s12962-020-0200-9. eCollection 2020.

Authors

Herbert H Loong^{1

2}, Carlos K H Wong³, Linda K S Leung^{1

2}, S C Tan⁴, Jason Jen⁵, Mary Y K Lee⁵, Raquel Aguiar-Ibáñez⁶, Jingshu Wang⁷

Affiliations

¹ 1Department of Clinical Oncology, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China.
² State Key Laboratory in Translational Research, Hong Kong Cancer Institute, Hong Kong, Hong Kong SAR, China.
³ 3Department of Family Medicine & Primary Care, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.
⁴ MSD Asia Pacific, Singapore, Singapore.
⁵ MSD, Hong Kong, Hong Kong.
⁶ 6Merck Sharp & Dohme B.V, Haarlem, The Netherlands.
⁷ 7MSD Kenilworth, Kenilworth, NJ USA.

Abstract

Background: Pembrolizumab has been shown to improve overall survival (OS) and progression free survival (PFS) compared to ipilimumab in patients with ipilimumab-naïve advanced melanoma; however, there are no published data on the cost-effectiveness for pembrolizumab compared to standard-of-care treatments currently used in Hong Kong for advanced melanoma.

Methods: A partitioned-survival model based on data from a recent randomized phase 3 study (KEYNOTE-006) and meta-analysis was used to derive time in PFS, OS, and post-progression survival for pembrolizumab and chemotherapy, such as dacarbazine (DTIC), temozolomide (TMZ), and the paclitaxel-carboplatin combination (PC). A combination of clinical trial data, published data, results of meta-analysis, and melanoma registry data was used to extrapolate PFS and OS curves. The base-case time horizon for the model was 30 years with costs and health outcomes discounted at a rate of 5% per year. Individual patient level data on utilities and frequencies of adverse events were obtained from the final analysis of KEYNOTE-006 (cut-off date: 3-Dec-15) for pembrolizumab. Cost data included drug acquisition, treatment administration, adverse event management, and clinical management of advanced melanoma. The distribution of patient weight from the Hong Kong population was applied to calculate the drug costs. Analyses were performed from a payer's perspective. The incremental cost effectiveness ratio (ICER) expressed as cost in US Dollars (USD) per quality-adjusted life years (QALYs) was the main outcome.

Results: In base-case scenario, the ICER for pembrolizumab as a first-line treatment for advanced melanoma was USD49,232 compared to DTIC, with the ICER values lower than cost-effectiveness threshold in Hong Kong. Results comparing pembrolizumab to TMZ and to PC were similar to that when compared to DTIC. Probability sensitivity analyses showed that 99% of the simulated ICERs were below three times the Gross Domestic Product (GDP) per capita for Hong Kong (currently at $119,274//QALY threshold). In a scenario analysis comparing pembrolizumab with ipilimumab, the estimated ICER was USD8,904.

Conclusions: Pembrolizumab is cost-effective relative to chemotherapy (DTIC, TMZ and PC), and highly-cost-effective compared to ipilimumab, for the first-line treatment of advanced melanoma in Hong Kong.