- Design
- Economic evaluation using a partitioned survival model based on KEYNOTE-689
- Population
- Simulated cohort with locally advanced head and neck squamous cell carcinoma
- Primary outcome
- Incremental cost-effectiveness ratio by PD-L1 CPS
- Effect
- CPS above 10: ICER $134,700 per QALY; CPS 1 to 10: ICER $2,179,400 per QALY
An economic evaluation built a partitioned survival model from digitised KEYNOTE-689 data for locally advanced head and neck squamous cell carcinoma, using US cost inputs, and stratified by PD-L1 combined positive score (CPS).
For CPS above 10, perioperative pembrolizumab gave about 1.35 extra quality-adjusted life-years at an extra $181,900, an incremental cost-effectiveness ratio of $134,700, with a 57% probability of being cost-effective at a $150,000 threshold. For CPS 1 to 10 the gain was about 0.08 QALYs at an extra $166,500, an ICER of $2,179,400, and an 11% probability of cost-effectiveness.
The CPS 1 to 10 subgroup was derived from other reported subgroups rather than taken directly from the trial, and all costs are American. Indian costs and access differ greatly, and the model says nothing about whether the drug is available or affordable here. It is useful as an argument for testing PD-L1 and for treating the score as a decision input.
- Ensure PD-L1 CPS is reported on head and neck resection or biopsy specimens.
- The model favoured treatment when CPS was above 10 and not in the 1 to 10 band.
- US costs do not transfer to Indian practice; check local pricing and access.
- The CPS 1 to 10 estimates were derived, not read directly from the trial.
Why it matters
It ties a biomarker result to the value of an expensive treatment, not just to its effect.
Don't overread it
A model built on published curves, with US costs, not an outcomes trial.
The statistics, in plain English
An ICER is the extra cost for each extra QALY gained; here $134,700 sits under the $150,000 threshold but the 57% probability means the answer is far from certain. The very high figure for CPS 1 to 10 reflects a tiny QALY gain.
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