23. SYSTEMATIC REVIEW OF THE COST - EFFECTIVENESS OF PEMBROLIZUMAB IN RECURRENT OR METASTATIC CERVICAL CANCER

Nguyen Minh Thuy1, Ha Van Thuy1, Bui Thi Xuan1, Phung Thao Nguyen2
1 VNU University of Medicine and Pharmacy
2 Hanoi University of Pharmacy

Main Article Content

Abstract

Objective: This systematic review evaluates methodological approaches, evidence quality, and outcomes of cost - effectiveness analyses for Pembrolizumab (Pem) in recurrent or metastatic cervical cancer.


Method: We systematically analysed cost - effectiveness analyses published between 2014 and 2024 from PubMed, ScienceDirect, Cochrane Library, and Google Scholar.


Results: Seven studies were selected. All included studies were conducted in the United States and China, with different model time horizons (5-50 years) and discount rates (3-5%). Comparator groups comprised: Atezolizumab + Bevacizumab + Chemotherapy; Bevacizumab + Chemotherapy; Pembrolizumab + Chemotherapy; Platinum-based Chemotherapy; and Placebo. Findings indicated that 57.1% of studies concluded Pembrolizumab was not cost - effective, 28.6% supported cost - effectiveness, and 14.3% were inconclusive.


Conclusion: Pembrolizumab improved clinical outcomes but demonstrated limited economic viability, with 57.1% of analyses deeming it non cost - effective due to high drug costs. Cost - effectiveness significantly improved in PD-L1 positive subgroups (CPS ≥ 1), supporting biomarker-guided personalized therapy.

Article Details

References

[1] National Cancer Institute. What Is Cervical Cancer?, https://www.cancer.gov/types/cervical, 2023. Accessed October 31, 2024.
[2] National Cancer Institute. Cervical Cancer Treatment by Stage, https://www.cancer.gov/types/cervical/treatment/by-stage, 2023. Accessed October 31, 2024.
[3] National Cancer Institute. Cervical Cancer Prognosis and Survival Rates, https://www.cancer.gov/types/cervical/survival, 2023. Accessed October 31, 2024.
[4] The Global Cancer Observatory. Globocan 2022 (version 1.1), World fact sheet, https://gco.iarc.who.int/media/globocan/factsheets/populations/900-world-fact-sheet.pdf, 2024.
[5] The Global Cancer Observatory. Globocan 2022 (version 1.1), Vietnam fact sheet, https://gco.iarc.who.int/media/globocan/factsheets/populations/704-viet-nam-fact-sheet.pdf, 2024.
[6] US Food and Drug Administration. FDA approves pembrolizumab combination for the first-line treatment of cervical cancer, https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-pembrolizumab-combination-first-line-treatment-cervical-cancer, 2021. Accessed October 31, 2024.
[7] Monk B.J, Colombo N, Tewari K.S et al. KEYNOTE-826: Final overall survival results from a randomized, double-blind, phase 3 study of Pembrolizumab + chemotherapy vs placebo + chemotherapy for first-line treatment of persistent, recurrent, or metastatic cervical cancer. J Clin Oncol, 2023, 41 (16_suppl): 5500-5500.
[8] Merck & Co., Inc. Cost Information and Financial Help With KEYTRUDA® (Pembrolizumab), https://www.keytruda.com/financial-support/. Accessed October 31, 2024.
[9] Husereau D, Drummond M, Augustovski F et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: Updated reporting guidance for health economic evaluations. Health Policy OPEN, 2022, 3: 100063.
[10] Shi Y, Chen J, Shi B, Liu A. Cost - effectiveness analysis of Pembrolizumab for treatment of US patients with persistent, recurrent, or metastatic cervical cancer. Gynecol Oncol, 2022, 164 (2): 379-385.
[11] Barrington D.A, Riedinger C, Haight P.J, Tubbs C, Cohn D.E. Pembrolizumab with or without bevacizumab for recurrent or metastatic cervical cancer: A cost - effectiveness analysis. Gynecol Oncol, 2022, 165 (3): 500-505.
[12] Richardson M.T, Attwood K, Smith G et al. Sequential Targeted Therapy for Advanced, Metastatic, and Recurrent Cervical Cancer: A Cost - Effectiveness Analysis of the Patient Journey. Cancer Control, 2023, 30: 10732748231182795.
[13] Ying-tao Lin, Wang C, He X Yan, Yao Q Min, Chen J. Comparative cost - effectiveness of first-line Pembrolizumab plus chemotherapy vs. chemotherapy alone in persistent, recurrent, or metastatic cervical cancer. Front Immunol, 2024, 14: 1345942.
[14] Zheng Z, Song X, Qiu G, Xu S, Cai H. Cost - effectiveness analysis of Pembrolizumab plus chemotherapy for patients with recurrent or metastatic cervical cancer in China. Curr Med Res Opin, 2023, 39 (3): 433-440.
[15] Monk B.J, Van Mens S, Hale O et al. Cost - Effectiveness of Pembrolizumab as First-Line Treatment in Patients with Persistent, Recurrent, or Metastatic Cervical Cancer in the United States. Oncol Ther, 2025, 13 (1): 85-98.
[16] Liang Y, Ma A. Cost - effectiveness analysis of immune checkpoint inhibitors combined with targeted therapy and chemotherapy for HPV/HIV-related cervical cancer. Medicine (Baltimore), 2024, 103 (48): e40678.
[17] Lorusso D, Xiang Y, Hasegawa K, Scambia G, Leiva M. Pembrolizumab or placebo with chemoradiotherapy followed by Pembrolizumab or placebo for newly diagnosed, high-risk, locally advanced cervical cancer (ENGOT-cx11/GOG-3047/KEYNOTE-A18): overall survival results from a randomised, double-blind, placebo-controlled, phase 3 trial, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01808-7/abstract, 2024, 403 (10434): 1341-1350.
[18] Cục Thống kê, Bộ Tài chính. Báo cáo tình hình kinh tế - xã hội quý IV và năm 2024, https://www.gso.gov.vn/bai-top/2025/01/bao-cao-tinh-hinh-kinh-te-xa-hoi-quy-iv-va-nam-2024/, 2025. Accessed April 16, 2025.
[19. Cục Quản lý Dược - Bộ Y tế. Tra cứu giá thuốc, https://dichvucong.dav.gov.vn/congbogiathuoc/index, 2024. Accessed April 16, 2025.
[20. Bộ Y Tế. Quyết định 779/QĐ-BYT Phê duyệt Chương trình hỗ trợ thuốc Keytruda (Pembrolizumab) miễn phí một phần không thuộc khoản viện trợ phi Chính phủ nước ngoài cho người bệnh ung thư do Công ty cổ phần Dược liệu Trung ương 2 thực hiện, 2020.
[21. Quỹ Ngày mai tươi sáng. Chương trình hỗ trợ thuốc Keytruda (Pembrolizumab) giai đoạn 2024 - 2026, https://ngaymaituoisang.vn/su-kien/chuong-trinh-ho-tro-thuoc-keytruda-pembrolizumab-giai-doan-2024---2026-13. Accessed February 4, 2025.