OBJECTIVES: Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer, associated with ultraviolet exposure, immunosuppression, and Merkel cell polyomavirus infections. This systematic literature review assessed model-based economic evaluations of PD-1 inhibitors used to manage MCC.

METHODS: Embase.com (Embase^® and MEDLINE^®) was systematically searched (from database inception until May 2023) to identify relevant English-language publications reporting the economic value of PD-1 inhibitors in patients with MCC. Searches were conducted in accordance with PRISMA guidelines. Publications were screened by two independent reviewers. Any discrepancy regarding the inclusion of studies was checked by a third reviewer.

RESULTS: Among the 67 citations retrieved from the electronic database searching, seven publications from four original studies met the inclusion criteria. The studies in Taiwan, Russia and the UK adopted a national healthcare perspective, while the study conducted in Portugal adopted a payer perspective. Cost–utility analyses were performed using partitioned survival models in Taiwan, Portugal and the UK, while the Russian study used cost-effectiveness analysis. The ICER for avelumab versus standard of care was $102,710 per life year gained (LYG) and $172,101 per progression-free LYG in Russia. In Portugal, the ICERs for avelumab versus doxorubicin were €35,057 and €30,576 per QALY and LYG, respectively. In Taiwan, avelumab was found to be a cost-effective management option for patients with both treatment-experienced and treatment-naïve metastatic MCC. The UK-based study demonstrated that avelumab might be a cost-effective treatment option for patients with treatment-experienced or treatment-naïve metastatic MCC, with ICERs versus chemotherapy, SoC and best supportive care ranging from £34,113 to £40,158.

CONCLUSIONS: This review found that avelumab can be considered a cost-effective option, taking into consideration the scarce nature of the disease. Although the FDA approved pembrolizumab (Keytruda) to treat patients with MCC, no economic evaluations concerning this indication were found in this review.