OBJECTIVES: The EMPOWER-Lung 3 trial showed that cemiplimab plus chemotherapy significantly prolongs the duration of progression-free survival and overall survival in advanced non-small cell lung cancer (NSCLC) patients with at least 50% programmed cell death receptor ligand-1 (PD-L1) positivity, yet the financial burden may limit its use. The aim of the present study was to evaluate the cost-effectiveness of cemiplimab plus chemotherapy versus cemiplimab alone in a US setting.

METHODS: A partitioned survival model was developed to capture time spent by patients in three health states: progression-free, progression, and death. Clinical outcomes from the EMPOWER-Lung 1 and 3 trial studies were obtained. In the absence of head-to-head studies, indirect treatment comparisons were conducted to capture the comparative effectiveness between cemiplimab plus chemotherapy and cemiplimab alone. A 20-year time horizon was adopted, and a 3% discount rate was applied to costs and utilities after year 1. Wholesale acquisition costs for treatments were sourced from Redbook, adverse event costs (grade 3/4; all grades for immunotherapy-related AEs) utilized published data, and monitoring costs were based on Physician Fee Schedules (US $2023).

RESULTS: Exponential regression was utilized to extrapolate the cemiplimab plus chemotherapy OS Kaplan-Meier curve, while Weibull regression was applied for extrapolation of the cemiplimab alone OS curve. For a 20-year time horizon, BCA (PSA) showed an incremental cost of cemiplimab plus chemotherapy over cemiplimab alone of $29,881 ($29,980), an incremental LY of 0.07 (0.07), and an incremental QALY of 0.05 (0.05), yielding an ICER of $453,594 ($455,091) per LY gained (g) and an ICUR of an incremental cost of $637,147 ($639,227) per QALYg.

CONCLUSIONS: This economic evaluation suggested that, in comparison with cemiplimab alone, cemiplimab plus chemotherapy combination was a slightly more cost-effective treatment option (insignificant difference) for non-small cell lung cancer (NSCLC) patients with at least 50% (PD-L1) in the US.