Cost-effectiveness analysis of pembrolizumab combined with gemcitabine and cisplatin for the first-line treatment for advanced cholangiocarcinoma
Wei Wang,
Lijun Xu,
Peilin Li,
Yongsheng Li,
Jing Wu,
Jihua Wang,
Shanshan Zhao,
Guangbing Li,
Shifeng Xu,
Huaiguang Chen,
Yuanwen Zheng
Affiliations
Wei Wang
Department of Intervention, The Second Hospital of Shandong University, Shandong, 250033, China
Lijun Xu
Department III of Radiotherapy, The Second People's Hospital of Dezhou City, Shandong, 253000, China
Peilin Li
Department of Hepatobiliary Surgery, The Second People's Hospital of Dezhou City, Shandong, 253000, China
Yongsheng Li
Mianyang Lide Electronics Co., LTD, Mianyang, 621000, China
Jing Wu
Department of Intervention, The Second Hospital of Shandong University, Shandong, 250033, China
Jihua Wang
Department of Oncology, The Second Hospital of Shandong University, Shandong, 250033, China
Shanshan Zhao
Department of Intervention, The Second Hospital of Shandong University, Shandong, 250033, China
Guangbing Li
Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250022, Shandong, China
Shifeng Xu
Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250022, Shandong, China
Huaiguang Chen
School of Science, Shandong Jianzhu University, Jinan, 250100, China; Corresponding author. Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250022, Shandong, China.
Yuanwen Zheng
Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250022, Shandong, China; Corresponding author. School of Science, Shandong Jianzhu University, Jinan, 250100, China.
Background: This study aims to assess the economic feasibility of incorporating pembrolizumab in combination with gemcitabine and cisplatin (GC) as the first-line therapy for patients with advanced cholangiocarcinoma (CCA) from the perspective of payers in the USA. Methods: A Markov model was developed to evaluate the cost-effectiveness of KEYNOTE-966. The model incorporated treatment effectiveness, event probabilities, and utilities. Expenses were determined based on data from published sources and nationwide surveys. The primary outcomes were measured in terms of quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to evaluate the uncertainty associated with the model. Results: The combination of pembrolizumab and GC yielded a significant cost increase of $60,963.53 and an additional 0.090 QALYs compared to GC alone. Consequently, the ICER reached $677,373 per QALY, surpassing the acceptable threshold of $150,000.00/QALY. Within the model, the hazard ratio of OS (0.86; ranging from 0.72 to 0.95) and the price of pembrolizumab ($6914.46, ranging from 5531.57 to 8297.35) emerged as the most influential factors. To achieve cost-effectiveness, the cost of pembrolizumab had to be decreased by 77.9 % to $1531 per cycle. Conclusion: The utilization of pembrolizumab and GC was not a cost-effective strategy for the first-line systemic treatment of advanced CCA, considering a willingness to pay limit of $150,000.00 per QALY.
