OBJECTIVES: Endometrial cancer is the 6th most common cancer globally. Pembrolizumab in combination with lenvatinib is reimbursed for the treatment of advanced or recurrent endometrial cancer following previous systemic therapy based on results from IA1 of KEYNOTE-775 trial. The present study aims to assess cost-effectiveness of Pembrolizumab plus lenvatinib versus paclitaxel/doxorubicin in Greece.

METHODS: A Partitioned Survival model with three health states (progression-free, progressed disease and death) was developed in Microsoft Excel, adopting payer’s perspective with a lifetime horizon of 35 years. Clinical, safety and quality of life data were drawn from KEYNOTE-775 trial and via literature review. Primary outcomes were patients’ life years gained (LYG), quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios (ICERs) per LYG and per QALY. Both costs and outcomes were discounted at 3.0% per annum. Α one-way sensitivity analysis was undertaken to examine the most influential parameters on the results and a probabilistic sensitivity analysis (PSA) was conducted to account for uncertainty in the model.

RESULTS: The model showed that, over a lifetime horizon, incremental cost per patient with pembrolizumab in combination with lenvatinib was estimated at 14,384€ compared to paclitaxel and 12,001€ compared to doxorubicin. Incremental LY’s were 2.31 and QALY’s 1.68 compared to both comparators. The ICER was estimated at 48,825€/QALY compared to paclitaxel and 50,248€/QALY compared to doxorubicin, which is below the national cost effectiveness threshold for Greece (52,770€/QALY). One way sensitivity analysis indicated that the most influential parameters on the model did not change results significantly such as shorter time horizon, and different parametric extrapolations. PSA confirmed the deterministic analysis results, indicating robustness of the results.

CONCLUSIONS: The present model-based study suggests that pembrolizumab in combination with lenvatinib compared to paclitaxel/doxorubicin improves QALY’s and Life-Years gained, and has a high likelihood of being cost-effective in Greece.