When compared to standard chemotherapy, the first-line combination of pembrolizumab plus lenvatinib (PL) for patients with mismatch repair-proficient (pMMR) advanced endometrial cancer (aEC) from the KEYNOTE-775 (NCT03517449) research had significantly better outcomes in 2022. Unfortunately, the expensive price of immune-targeted therapy means that its broad adoption among patients is still in question. As a result, researchers analyzed the relative costs of PL and chemotherapy. They developed a comprehensive Markov model, including 697 patients, that calculated total cost, life-years (LYs), quality-adjusted life-years (QALYs), and an incremental cost-effectiveness ratio (ICER) at a willingness-to-pay (WTP) threshold of $150,000 per QALY to compare the cost-effectiveness of PL versus chemotherapy over 7 years. About 1-way, 2-way, and probabilistic sensitivity assessments were performed to gauge the model’s sturdiness. They also analyzed the data in several categories. Costing an average of $163,777 per patient, chemotherapy was found to extend life by an average of 0.705 QALYs (0.901 LYs). In comparison to chemotherapy, PL was linked with a higher incremental cost of $38,582 and a lower incremental gain of 0.349 QALYs, for an ICER of $110,401 per QALY. Pembrolizumab’s price was a major factor in determining the ICER. Approximately 79.2% of simulations show cost-effectiveness in PL at the estimated WTP threshold of $150,000 per QALY. A subgroup analysis demonstrated the cost-effectiveness of PL for patients who had only received 1 prior line of therapy. At a WTP of $150,000, the PL approach may be the most cost-effective option for patients with pMMR aEC in the United States.

Source: sciencedirect.com/science/article/pii/S009082582200419X