This economic evaluation used a partitioned survival model to assess the cost-effectiveness of perioperative pembrolizumab added to standard of care (surgery, cisplatin, radiation) for locally advanced HNSCC, stratified by PD-L1 combined positive score (CPS >10 vs. CPS 1–10), based on KEYNOTE-689 trial data.
For CPS >10 patients, pembrolizumab yielded ~1.35 additional QALYs at an incremental cost of $181,900 (ICER $134,700/QALY; 57% probability of cost-effectiveness at $150,000 WTP). For CPS 1–10 patients, it added only ~0.08 QALYs at $166,500 incremental cost (ICER $2,179,400/QALY; 11% probability of cost-effectiveness at $150,000 WTP).
- Model inputs for QALYs were borrowed from a different trial (CheckMate 141), not directly from KEYNOTE-689 patients. - CPS 1–10 subgroup data were mathematically derived from two reported subgroups rather than directly observed. - The 57% cost-effectiveness probability for CPS >10 reflects substantial residual uncertainty.
Consider PD-L1 CPS testing before offering perioperative pembrolizumab for locally advanced HNSCC — the drug appears cost-effective only in patients with CPS >10. Routine use in CPS 1–10 patients is not supported on value-based grounds at current pricing.
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