OBJECTIVES: Pembrolizumab, a monoclonal antibody binding to the protein PD-1, in combination with chemotherapy (PCT) has been a cost-effective, first-line treatment for patients with advanced non-small cell lung cancer (NSCLC) regardless of PD-L1 levels. In 2022, the U.S. FDA approved cemiplimab, in combination with chemotherapy (CCT), as another first-line treatment. This study evaluated the cost-effectiveness of CCT versus PCT for patients with advanced NSCLC from a U.S. healthcare payer perspective.

METHODS: We constructed a Markov model to evaluate the cost-effectiveness of CCT compared to PCT as the first-line treatment for patients with advanced NSCLC. The time horizon for the model was 10 years. The effectiveness and transition probabilities of CCT and PCT treatment regimens were extracted from the survival data of the EMPOWER-LUNG 3 trial and a network meta-analysis, respectively. Treatments’ costs were obtained from the Centers for Medicare & Medicaid Services October 2023 Part B Drug Average Sales Price file. Other parameters, such as incidence and cost of adverse events, as well as patients' utilities at different progression stages, were obtained from published literature. The costs, QALYs, and their incremental values of the two regimens were calculated.

RESULTS: The first-line treatment with the CCT regimen was less costly and less effective than the PCT regimen. Specifically, the CCT regimen cost $211,600 for 2.79 QALYs, while the PCT regimen cost $398,399 for 3.20 QALYs. The incremental cost (-$186,799) and the incremental outcome (-0.41 QALYs) reflected that the CCT regimen saved $457,382 per QALY lost.

CONCLUSIONS: Our preliminary study showed that using a CCT regimen would result in lower costs with a loss of health outcome compared to using a PCT regimen as a first-line treatment for advanced NSCLC in the US. However, sensitivity analyses should be performed to confirm the robustness of the main findings.