Pembrolizumab plus Chemotherapy in Advanced Endometrial Cancer: a cost-effectiveness analysis

Abstract Objectives Recently, NRG-GY018 clinical trial have demonstrated that adding pembrolizumab to chemotherapy led to significantly longer progression-free survival than chemotherapy alone in the first-line treatment of advanced endometrial cancer (aECs). This analysis aimed to estimate the cost-effectiveness of pembrolizumab plus chemotherapy (PC) as the first-line treatment for aECs in the US and China. Methods A Markov model based on the data from NRG-GY018 trial was established to estimate the cost and efficacy of pembrolizumab plus chemotherapy and chemotherapy groups for aECs in mismatch repair-proficient (pMMR) and mismatch repair–deficient (dMMR) populations. The main outcomes were incremental cost-effectiveness ratios (ICERs), incremental monetary benefit (INMB), and incremental net-health benefit (INHB). Direct medical costs and utility values were collected from the government databases, local databases, and published literatures. The robustness of the model was assessed using one-way and probabilistic sensitivity analyses. Results Treatment with PC gained an additional 1.06 QALYs (1.34 LYs) in pMMR and 4.10 QALYs (5.14 LYs) in the dMMR population. In the US, the ICERs of PC compared to chemotherapy were 346,720 $/QALY in pMMR and 125,006 $/QALY in dMMR patients, respectively. In China, the ICERs of PC compared to chemotherapy were 176,313 $/QALY and 71,645 $/QALY in pMMR and dMMR populations. The results of sensitivity analyses supported the robustness of our models. Conclusions For patients with aECs, PC was cost-effective compared with chemotherapy in the first-line treatment for dMMR populations in the US. However, to reach the traditional cost-effectiveness threshold in China, a price reduction of pembrolizumab is required.