Pembrolizumab plus paclitaxel with optional bevacizumab for platinum-resistant recurrent ovarian cancer with PD-L1 CPS ≥ 1: a cost-effectiveness analysis

Patients with platinum-resistant recurrent ovarian cancer (PRROC) have limited therapeutic options. Pembrolizumab plus paclitaxel with optional bevacizumab (pembrolizumab group) has recently emerged as a promising therapeutic strategy for this population. Nevertheless, the high acquisition and treatment costs associated with this regimen raise important concerns regarding its economic value, making a formal cost-effectiveness evaluation essential. A three-state Markov model with a 15-year time horizon was constructed using clinical efficacy data from the KEYNOTE-B96 trial together with treatment-related cost inputs for estimating lifetime costs and health outcomes for PRROC patients with PD-L1 combined positive score (CPS) ≥ 1 receiving either the pembrolizumab regimen or placebo. Outcomes included total costs, quality-adjusted life-years (QALYs), incremental net health benefits (INHBs), and incremental cost-effectiveness ratios (ICERs). Cost-effectiveness was assessed using willingness-to-pay (WTP) thresholds of $150,000/QALY for the USA and $40,500/QALY for China. In the USA, treatment with pembrolizumab resulted in an additional cost of $214,982 and a gain of 0.29 QALYs compared with placebo. In China, the corresponding incremental cost and QALY gain were $16,459 and 0.27, respectively. The resulting ICERs were $752,613/QALY in the USA and $61,777/QALY in China, with associated INHBs of -1.14 QALYs and -0.14 QALYs, respectively. Sensitivity analyses showed that when pembrolizumab prices were reduced by 10% in the USA and 30% in China, the ICERs declined to levels below the respective WTP thresholds. At current market prices, pembrolizumab plus paclitaxel with optional bevacizumab does not represent a cost-effective option for PRROC. However, price reductions for pembrolizumab could substantially improve its economic attractiveness.