Cost-effectiveness of pembrolizumab as a treatment for FIGO 2014 stage III–IVA cervical cancer in the United States

OBJECTIVES: The FDA approved pembrolizumab in combination with chemoradiotherapy (CRT) for treating patients with FIGO 2014 Stage III-IVA cervical cancer in January 2024. This study evaluates the cost-effectiveness of pembrolizumab plus CRT versus CRT alone in this patient population from a US payer perspective. METHODS: A state-transition cohort model was developed with four health states: progression-free, first progression, second progression, and death. Time-dependent transition probabilities were derived from parametric survival analyses of patient-level data (from the final analysis of the KEYNOTE-A18 trial. Projections for endpoints after first progression were adjusted by expected pembrolizumab utilization in recurrent or metastatic cervical cancer in US clinical practice. Adverse event rates and utility values were based on KEYNOTE-A18. Costs were sourced from Analysource, national statistics, and literature. Outcomes were discounted at 3% annually over patients' lifetime. Parameter and structural uncertainty were assessed through deterministic and probabilistic sensitivity analyses. RESULTS: Patients receiving pembrolizumab plus CRT were projected to gain 1.87 life years (LYs) and 1.60 quality-adjusted life years (QALYs) and incur incremental costs of $157,681 compared with CRT alone, yielding an incremental cost-effectiveness ratio of $98,292/QALY. In probabilistic sensitivity analyses, pembrolizumab plus CRT has a 90% chance of being cost-effective at a willingness-to-pay (WTP) threshold of $150,000/QALY. CONCLUSIONS: Pembrolizumab plus CRT offers substantial clinical benefits over treatment with CRT alone and is projected to be cost-effective at a WTP threshold of $150,000. Pembrolizumab plus CRT is a much-needed additional treatment option for patients with FIGO 2014 Stage III-IVA cervical cancer in the US.