Combined Positive Score and Cost-Effectiveness of Perioperative Pembrolizumab for Head and Neck Cancer.
Perioperative pembrolizumab is cost-effective for head and neck cancer with PD-L1 combined positive score over 10.
Combined Positive Score and Cost-Effectiveness of Perioperative Pembrolizumab for Head and Neck Cancer.
To evaluate the cost-effectiveness of the KEYNOTE-689 perioperative pembrolizumab protocol.
DESIGN, SETTING, AND PARTICIPANTS: A partitioned survival model simulated the KEYNOTE-689 trial cohort with 3 mutually exclusive health states: event-free survival, disease progression, and death.
Subgroup analyses based on PD-L1 expression yielded divergent results.
Probabilistic sensitivity analysis showed a 57% probability that the pembrolizumab strategy was cost-effective at a $150 000 willingness-to-pay (WTP) threshold.
In the combined positive score of 1 to 10 cohort, perioperative pembrolizumab resulted in approximately 0.08 additional QALYs at an incremental cost of $166 500, for an incremental cost-effectiveness ratio of $2 179 400, with the probabilistic sensitivity analysis demonstrating an 11% probability of cost-effectiveness at a $150 000 WTP threshold.
In this economic evaluation, addition of perioperative pembrolizumab to standard treatment for locally advanced head and neck squamous cell carcinoma may represent a cost-effective intervention for patients with a PD-L1 combined positive score greater than 10 if KEYNOTE-689 data are replicable in clinical practice.
Perioperative pembrolizumab is not a cost-effective strategy for patients with a combined positive score less than 10 based on current data.
Biomarker stratification may inform the value-based integration of immunotherapy among patients with head and neck squamous cell carcinoma.