{"id":22657,"date":"2025-10-08T13:49:35","date_gmt":"2025-10-08T17:49:35","guid":{"rendered":"https:\/\/www.ices.on.ca\/?post_type=journal_article&#038;p=22657"},"modified":"2025-10-16T13:56:41","modified_gmt":"2025-10-16T17:56:41","slug":"pembrolizumab-vs-chemotherapy-in-the-first-line-setting-of-pd-l1-50-metastatic-non-small-cell-lung-cancer","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/pembrolizumab-vs-chemotherapy-in-the-first-line-setting-of-pd-l1-50-metastatic-non-small-cell-lung-cancer\/","title":{"rendered":"Pembrolizumab vs. chemotherapy in the first-line setting of PD-L1 \u2265 50% metastatic non-small cell lung cancer: a real-world cost-effectiveness analysis"},"content":{"rendered":"<p><strong>Background<\/strong> \u2014 The initial health technology assessments (HTA) for first-line pembrolizumab in PD-L1\u226550% metastatic non-small cell lung cancer (mNSCLC) concluded that pembrolizumab could not be considered cost-effective based on clinical trial findings. We evaluated the real-world cost-effectiveness of first-line pembrolizumab versus platinum-based chemotherapy for PD-L1\u226550% mNSCLC patients.<\/p>\n<p><strong>Methods<\/strong> \u2014 We retrospectively identified a population-based cohort of mNSCLC patients who received first-line pembrolizumab or platinum-based chemotherapy between April 2013 and March 2021, in Ontario, Canada. Propensity-score matching (1:1) was performed to balance covariates between the groups. Employing a public payer\u2019s perspective, all costs (CAD) and outcomes were estimated over a 4-year time horizon, adjusted for censoring and discounted at 1.5% yearly. Primary outcomes were life-years gained (LYG), quality-adjusted life years (QALY) and incremental cost-effectiveness ratios (ICER). To examine the sensitivity of the ICER to drug acquisition costs and discounting, we conducted a price reduction analysis and a scenario analysis of different discount rates.<\/p>\n<p><strong>Results<\/strong> \u2014 Propensity-score matching resulted in a total of 1,142 pairs of mNSCLC patients. Pembrolizumab extended survival with an incremental effect of 0.37 LYG and 0.35 QALY, but at an incremental cost of $56,681; the resulting ICERs were $154,941\/LYG and $163,039\/QALY. Though the ICERs were not sensitive to discounting rate, pembrolizumab price reductions of 31% and 55% were required to achieve cost-effectiveness at cost-effectiveness thresholds of $100,000\/QALY and $50,000\/QALY, respectively.<\/p>\n<p><strong>Conclusion<\/strong> \u2014 In the real world, first-line pembrolizumab improves survival, but is not considered to be cost-effective for PD-L1\u226550% mNSCLC. Improvements in cost-effectiveness, however, may be achievable through price renegotiations for pembrolizumab.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background \u2014 The initial health technology assessments (HTA) for first-line pembrolizumab in PD-L1\u226550% metastatic non-small cell lung cancer (mNSCLC) concluded that pembrolizumab could not be considered cost-effective based on clinical trial findings. We evaluated the real-world cost-effectiveness of first-line pembrolizumab versus platinum-based chemotherapy for PD-L1\u226550% mNSCLC patients. Methods \u2014 We retrospectively identified a population-based cohort [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[38,61,56],"migration-helper-qa-sample-set":[],"class_list":["post-22657","journal_article","type-journal_article","status-publish","hentry","topic-cancer-and-cancer-screening","topic-health-economics","topic-pharmacoepidemiology-and-drug-safety"],"acf":{"citation":"Liu B, Parmar A, Luo J, Dai WF, Chan KKW. <em>Eur J Health Econ<\/em>. 2025; Oct 8 [Epub ahead of print].","source_url":"https:\/\/doi.org\/10.1007\/s10198-025-01827-x","ices_scientist":[1185],"site":[6733],"research_program":[6741],"news_release":"","journal_article":"","atlas":"","research_report":"","infographic":"","video":"","downloads":null,"links":null,"sitecore_item_id":"","sitecore_item_name":"","sitecore_field_values":"","previous_url":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - 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