Pembrolizumab Plus Chemotherapy Improves Survival in mNSCLC at Higher Cost
Key Takeaways:
- Pembrolizumab plus chemotherapy increases life expectancy for patients with metastatic non–small cell lung cancer (mNSCLC). Patients treated with pembrolizumab plus chemotherapy had a higher life expectancy than patients treated with cemiplimab plus chemotherapy.
- Quality-adjusted life years (QALYs) were higher for patients treated with pembrolizumab plus chemotherapy. Non-squamous mNSCLC patients had a QALY gain of 0.71, and squamous patients had a QALY gain of 0.43.
- Pembrolizumab plus chemotherapy resulted in higher incremental costs than cemiplimab plus chemotherapy. Non-squamous patients had an increased cost of $43 131, which resulted in an incremental cost-effectiveness ratio (ICER) of $60 957. Squamous patients had an incremental cost of $34 675, resulting in an ICER of $80 218.
Immunotherapy combined with chemotherapy is the standard treatment for patients with mNSCLC. Pembrolizumab and cemiplimab are both recommended by major oncology organizations for treatment use. This study compared the cost-effectiveness of pembrolizumab plus chemotherapy and cemiplimab plus chemotherapy.
This study used a matching-adjusted indirect comparison (MAIC) model to evaluate data from the KEYNOTE-189, KEYNOTE-407, and EMPOWER-Lung 3 clinical trials. Using a 20-year time horizon, the study assessed the costs, QUALYs, and ICERs of pembrolizumab plus chemotherapy versus cemiplimab plus chemotherapy.
Survival Gains Observed With Pembrolizumab-Based Therapy
Pembrolizumab plus chemotherapy improved survival in both squamous and non-squamous mNSCLC. Patients with non-squamous mNSCLC gained a discounted life expectancy of 0.84 years (3.31 vs 2.46 years) and an undiscounted life expectancy of 1.03 years (3.78 vs 2.75 years). Squamous mNSCLC patients gained a discounted life expectancy of 0.51 years (2.82 vs 2.31 years) and an undiscounted life expectancy of 0.60 years (3.15 vs 2.55 years).
Patients treated with pembrolizumab plus chemotherapy also had improved QALYs. Non-squamous patients had a QALY gain of 0.71. Squamous patients had a QALY gain of 0.43.
Pembrolizumab plus chemotherapy also had slightly higher care costs, attributed to the higher costs associated with longer survival. Non-squamous patients had an increased discounted cost of $43 131 while squamous patients had an incremental cost of $34 675.
The ICER is calculated by diving incremental costs by QALYs gained. Non-squamous patients receiving pembrolizumab plus chemotherapy had an ICER of $60 957 per QALY gained, and squamous patients had an ICER of $80 218 per QALY gained.
Data Highlight Trade-Off Between Cost and Survival
The study’s findings show that pembrolizumab plus chemotherapy is more effective than cemiplimab plus chemotherapy but has a higher cost.
According to the authors, “In practical terms, our results suggest that pembrolizumab plus chemotherapy is likely to offer longer survival and quality-adjusted survival than cemiplimab plus chemotherapy for patients with metastatic NSCLC, at an additional cost that appears acceptable under commonly cited US cost-effectiveness thresholds.”
Reference
Huang D, Zhang Y, Babel RA, et al. Cost-effectiveness of pembrolizumab plus chemotherapy vs cemiplimab plus chemotherapy for first-line metastatic non–small cell lung cancer: a US payer perspective using a matching-adjusted indirect comparison. J Med Econ. 2026;29(1):889-908. doi:10.1080/13696998.2026.2639229
