Evaluating the Cost-Effectiveness of Pembrolizumab Monotherapy in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma

The treatment landscape for recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) has witnessed significant advancements with the introduction of programmed death receptor 1 (PD-1) inhibitors like pembrolizumab. The KEYNOTE-048 trial, a phase III study, demonstrated that pembrolizumab monotherapy improved survival outcomes for patients with CPS ≥1 population and those who received combination therapy with platinum + 5-fluorouracil in the total population.

The study's findings have significant implications for healthcare policymakers and providers. From a social security perspective in Argentina, researchers evaluated the cost-effectiveness of pembrolizumab monotherapy compared to cetuximab + platinum + 5-fluorouracil. The results showed that patients who received pembrolizumab monotherapy accrued an additional 1.1040 life-years and 0.8768 quality-adjusted life-years (QALYs), resulting in incremental cost-effectiveness ratios (ICERs) of AR $135,801 per life-year gained and AR $170,985 per QALY gained.

To derive utilities, the researchers employed an Argentina-specific algorithm, while time-on-treatment and EuroQol five-dimension scores were obtained from KEYNOTE-048. The study accounted for costs related to initial and subsequent treatments, disease and adverse events management, as well as terminal care. These costs were adjusted using a conversion rate of AR $74.00 per 1 USD.

The health state occupancy was modeled using Kaplan-Meier curves until the final analysis data cutoff, followed by parametric extrapolations guided by statistical criteria. A partitioned survival model projected costs and outcomes over 20 years with 3% annual discounting.

In conclusion, this study provides valuable insights into the cost-effectiveness of pembrolizumab monotherapy in the treatment of recurrent or metastatic HNSCC from a social security perspective in Argentina. The findings suggest that pembrolizumab may be a more effective and cost-effective option compared to cetuximab + platinum + 5-fluorouracil, particularly for patients with CPS ≥1 population. As healthcare providers continue to navigate the complexities of HNSCC treatment, this study's results can inform decision-making and help optimize patient care.

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