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Wan Ling Tan

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    P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.16-07 - Cost-Effectiveness of Pembrolizumab as 1st Line Treatment for Metastatic NSCLC Patients with High PD-L1 Expression in Singapore (ID 11719)

      16:45 - 18:00  |  Presenting Author(s): Wan Ling Tan

      • Abstract
      • Slides


      Pembrolizumab, an immune checkpoint inhibitor, has been approved as monotherapy for 1st line treatment of metastatic NSCLC with PD-L1 tumor proportion score (TPS) ≥50% based on the pivotal Keynote (KN)-024 study. This study aims to evaluate the cost-effectiveness of pembrolizumab compared with standard-of-care (SoC) platinum-based chemotherapy in patients with TPS≥50% from a societal perspective in Singapore based on results from KN024.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      A known partitioned-survival model was adapted to estimate progression-free survival, overall survival, costs of treatments, adverse events and disease management, and health utilities over a time horizon of 20 years. The maximum treatment duration of 2 years was applied for pembrolizumab. Clinical and resource utilization inputs were based on data from KN024 study and input from local oncologists. Unit costs captured both patients’ payments and government subsidies. Utility scores in different health states were based on EQ-5D data from KN024 with weighting indices suggested by a local quality-of-life study. An annual discount rate of 3% was applied and a series of sensitivity and scenario analyses were conducted to address uncertainty.

      4c3880bb027f159e801041b1021e88e8 Result

      For 1st line treatment for NSCLC patients with TPS≥50%, pembrolizumab monotherapy is estimated to result in 0.91 quality-adjusted-life-years (QALY) gained. The projected incremental cost for pembrolizumab is S$141,979 compared to SoC, leading to an incremental cost-effectiveness ratio (ICER) of S$155,630 per QALY gained. A similar ICER of S$156,862 is observed in a scenario analysis whereby all patients are tested for PD-L1 and those with high PD-L1 expression are treated with pembrolizumab. With a Pembrolizumab Patient Access Program (PAP), the ICER is estimated to be S$95,279 per QALY. In another scenario analysis where government subsidies and claim limits of Medishield / Medisave are considered, the estimated ICER is S$46,308 per QALY from the Ministry of Health (MOH) perspective.

      8eea62084ca7e541d918e823422bd82e Conclusion

      For NSCLC patients with TPS≥50%, the ICER in the base-case for pembrolizumab as 1st-line treatment is $155,630 – which is between 2-3x gross domestic product (GDP) per capita of Singapore (S$73,167) in 2016, whereas the estimated ICER with Pembrolizumab PAP is 1-2x GDP per capita. Depending on threshold boundaries adopted, 1st line pembrolizumab for patients with similar profile (TPS ≥50%) as those in KN024, would be a cost-effective treatment compared to SoC in Singapore.


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