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Cost Analysis of Personalized vs Fixed Dosing of Pembrolizumab

Posted: Friday, July 14, 2017

Daniel A. Goldstein, MD, of Davidoff Cancer Center, Rabin Medical Center, Petach Tikvah, Israel, and colleagues found that personalized dosing of pembrolizumab may have the potential to save millions of dollars annually in the United States, likely without impacting outcomes. The findings of this pharmacologic analysis comparing personalized and fixed dosing of pembrolizumab in the first-line treatment of patients with programmed cell death ligand 1 (PD-L1)–positive non–small cell lung cancer (NSCLC) were published in the Journal of the National Cancer Institute.

For patients with metastatic NSCLC whose tumors express PD-L1 in at least 50% of cells, pembrolizumab has become the standard of care in first-line treatment. The recommended dose is 200 mg every 3 weeks.

In the investigators’ budget impact analysis, the economic impact of using personalized dosing (2 mg/kg) vs fixed dosing (200 mg) was assessed. They used survival curves from the KEYNOTE 024 trial to estimate the mean number of cycles patients would receive.

Their base case model showed the total annual cost of pembrolizumab with fixed dosing was higher than that with personalized dosing—US $3,440,127,429 vs. US $2,614,496,846. This finding suggests a 24% annual savings of US $825,630,583 with the use of personalized dosing.