Cost-effectivenes of addition of pembrolizumab to chemoradiotherapy for locally advanced cervical cancer

The multinational phase 3 KEYNOTE-A18 trial found that addition of concurrent and adjuvant pembrolizumab versus placebo to chemoradiotherapy (CRT) for newly diagnosed locally advanced cervical cancer was associated with improved progression-free survival. Economic evaluation of data from KEYNOTE-A18 found that addition of pembrolizumab increased costs by $ 257,000 and effectiviness by 1.40 quality-adjusted life-years, yielding an incremental cost-effectiveness ratio of $ 183,400 per QALY, meaning that addition of pembrolizumab is not cost-effective at a willingness-to-pay threshold of $ 100,000 per QALY. The addition of pembrolizumab became cost-effective if its cost was decreased by 46.5% or its maximum duration of 24 months was decreased to 10 months. The authors conclude that addition of pembrolizumab to CRT for newly diagnosed locally advanced cervical cancer according to the KEYNOTE-A18 schedule was not cost-effective, despite improved survival with this regimen.