ArticleFrontiers in pharmacology2025
Cost-effectiveness analysis of pembrolizumab plus chemotherapy versus placebo plus chemotherapy for patients with previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer in China.
Article in Frontiers in pharmacology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The present study aimed to evaluate the cost-effectiveness of pembrolizumab combined with chemotherapy versus placebo plus chemotherapy for patients with previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer from the perspective of the Chinese healthcare system. Methods: A Markov model was developed to track patients' transitions over 3-week cycles and evaluate the health and economic outcomes over a 10-year horizon for the two competing treatments. The survival data were gathered from the KEYNOTE-355 trial, and cost and utility values were obtained from the published studies. Total costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) were the model outcomes. We conducted analysis based on patients' programmed death-ligand 1 (PD-L1) combined positive score (CPS), including subgroups with CPS≥10, CPS≥1, and the intention-to-treat population. One-way sensitivity analysis, probabilistic sensitivity analysis and scenario analysis were performed to examine the robustness of the model results. Results: In the base case analysis for patients highly expressing PD-L1 (CPS≥10), pembrolizumab plus chemotherapy yielded a marginal cost of $85,838.75 and an additional 0.47 QALYs, resulting in an ICER of $184,030.56 per additional QALY gained, which exceeded the willingness-to-pay (WTP) threshold of $38,224 per QALY in China. And the ICERs were $319,506.90/QALY for patients lowly expressing PD-L1 (CPS≥1) and $776,786.75/QALY for the intention-to-treat population. Sensitivity analyses confirmed the robustness of the model outcomes. Scenario analysis demonstrated that price reductions for pembrolizumab could enhance its likelihood of achieving cost-effectiveness. Conclusion: The findings of this cost-effectiveness analysis suggest that pembrolizumab plus chemotherapy was not a cost-effective treatment for patients with previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer in China.
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