Study: Cemiplimab More Cost-effective Than Chemotherapy for Some Patients With NSCLC

In the United States, cemiplimab serves as a cost-effective option for first-line treatment of non–small cell lung cancer (NSCLC) in patients who are at least 50% programmed cell death receptor ligand-1 (PD-L1) positive, according to an analysis published in Clinical Oncology.

Although platinum-doublet chemotherapy used to be the only option for first-line treatment in patients with NSCLC negative for actional molecular markers, advances in immunotherapy present an opportunity for new paradigms, researchers explained.

One potential alternative to chemotherapy is cemiplimab, “a recombinant human IgG4 monoclonal PD-1 antibody that blocks the interaction between PD-1 and PD-L1/PD-L2,” authors wrote. Results from the phase 3 EMPOWER-Lung 1 trial showed cemiplimab resulted in improved overall survival compared with chemotherapy and was less likely to be associated with treatment-related adverse events of grade 3 or higher.

To better understand the financial burden of the novel anti–PD-1 treatment, investigators conducted a cost-effectiveness analysis using clinical data from the EMPOWER-Lung 1 trial.

“Patients with a tumor proportion score >50% were randomly allocated to receive either cemiplimab 350 mg intravenously every 3 weeks for up to 108 weeks or 4 to 6 cycles of platinum-doublet chemotherapy, based on the trial,” authors wrote. Patients were also permitted to cross over if disease progression occurred following first-line treatment.

In their model, researchers presumed 74% of those in the cemiplimab arm received chemotherapy, and 23% in the chemotherapy group received cemiplimab, based off the data in the clinical trial.

Their decision tree and Markov model also included any adverse events grade 3 or higher or those occurring at a frequency of 5% or greater. In addition, “the cost of each treatment arm consisted of the costs of drugs, drug administration, laboratory tests, radiographic imaging, follow-up appointments, treatment of adverse events and terminal care,” while “a typical patient with a weight of 89 kg and body surface area of 1.84 m² was used to calculate dosage data for intravenous drug administration.”

Health outcomes were calculated as quality-adjusted life-years (QALYs) and cost-effectiveness was converted to incremental cost-effectiveness ratios (ICERs).

Analyses revealed:

• Over 20 years, treatment of NSCLC with cemiplimab yielded an extra 1.07 QALYs at an additional cost of $98,211 compared with chemotherapy.
• Cemiplimab treatment was associated with an ICER of $91,891/QALY and an incremental net health benefit of 0.087 QALYs at a willingness to pay (WTP) threshold of $100,000/QALY.
• The probabilistic sensitivity analysis indicated that cemiplimab provided an 83.2% probability of being cost-effective and that platinum-doublet chemotherapy had a 15.7% probability of cost-effectiveness.
• A one-way sensitivity analysis suggested that the price of cemiplimab was the chief driver in this model.
• A subgroup analysis showed that cemiplimab was the preferred incremental net health benefit in more than half of the subgroups, including patients with squamous type disease and metastases.

The one-way sensitivity analysis also showed that the hazard ratio for progression free survival (PFS)—with improved health mainly derived from a decreased risk of disease progression—served as the pivotal driving factor for ICER, authors explained.

Findings of the current analysis may not be generalizable to other countries, in part due to different WTP thresholds. However, “when considering WTP in middle-income regions, if the price of cemiplimab per 50 mg was set at less than $925, the ICER could be less than $30,000, suggesting that cemiplimab would also be cost-effective in those locations,” they said.

The retrospective nature of data on survival and adverse events used in this analysis marks a limitation, while additional research on the impact of different treatment regimens on individual quality of life is warranted.

Overall, “the present study shows that for advanced NSCLC with PD-L1 > 50%, cemiplimab appears to be a more cost-effective treatment option than chemotherapy at the current WTP threshold of $100,000/QALY in the USA,” authors concluded.

“Meanwhile, health economics evaluations may provide an opportunity to aid the development of precision medicine depending on the individual characteristics of NSCLC patients.”

Reference:

Zhang M, Liu X, Wen F, et al. First-line cemiplimab versus standard chemotherapy in advanced non-small cell lung cancer patients with at least 50% programmed cell death receptor ligand-1 positivity: analysis of cost-effectiveness. Clin Oncol (R Coll Radiol). Published online November 2, 2021. doi:10.1016/j.clon.2021.10.008