Pharmacoeconomic analysis of pembrolizumab in combination with chemotherapy as the first line of advances non-squamous non-small cell lung cancer treatment


S.K. Zyryanov (1), M.Yu. Frolov (2, 3), M.V. Zhuravleva (4), V.A. Rogov (2), D.D. Sakaeva (5)

1 N.I. Pirogov Russian National Research Medical University, Moscow, Russia; 2 Volgograd State Medical University, Volgograd, Russia; 3 Association of Clinical Pharmacologists, Volgograd, Russia; 4 I.M. Sechenov First Moscow State Medical University (Sechenov University), , Moscow, Russia; 5 Republican Clinical Oncological Dispensary, Bashkir State Medical University, Ufa, Russia
Background. Lung cancer is the most common cause of death among oncology diseases in the Russian Federation and represents a serious social and economic problem. Until recently, for patients without activated mutations, standard chemotherapy (СT) was the only treatment option. The PD-1 receptor inhibitor pembrolizumab is the first drug that, in combination with HT, has shown efficacy in patients with advanced non-squamous NSCLC in the first line of therapy. Objective: to evaluate the cost-effectiveness of using pembrolizumab in combination with СT in the first line of conventional non-squamous NSCLC therapy in frame of Russian public health care system.
Methods. The use of pembrolizumab in combination with platinum-based chemotherapy and pemetrexed was compared with platinum-based chemotherapy and pemetrexed therapy in the first line of common non-squamous NSCLC. The Markov model was developed to estimate the number of life years saved and direct medical costs for compared treatment regimens, based on data from the KEYNOTE-189 clinical study. Additionally, «cost/effectiveness» and «cost/utility» analyzes were performed.
Results. 5-year general direct costs per patient on pembrolizumab with СT (7,06 million rubs.) is higher than the cost on СT (4,35 million rubs.). The «cost/effectiveness» ratio for a life year for therapy with pembrolizumab with СT is 2,67 million rubs., and 2,72 million rubs. for СT. The «cost/utility» ratio for quality adjusted life year for pembrolizumab therapy with СT is 3,65 million rubs, and 3,96 million rubs. for СT.
Conclusion. The use of pembrolizumab in combination with СT is economically feasible in the first line of therapy of common non-squamous NSCLC in the healthcare conditions of the Russian Federation.
Keywords: non-small cell lung cancer, PD-1 receptor inhibitor, pembrolizumab, pemetrexed, pharmacoeconomic analysis, cost-effectiveness analysis, cost-utility analysis

About the Autors

Corresponding author: Dina D. Sakaeva, MD, Deputy Chief Physician for Chemotherapy, Republican Clinical Oncological Dispensary, Ufa, Russia; e-mail:
Address: 73/1, Prospekt Oktyabrya, Ufa, 450054 Russian Federation

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