Authors
Ruixuan Liu, Zhen Wang, Xueli Yang, Yong Xiao, Zeqin Liu, Qing Yang
Published in
Expert review of pharmacoeconomics & outcomes research. Oct 30, 2026. Epub Oct 30, 2026.
Abstract
The KEYNOTE-689 trial demonstrated clinical benefits of perioperative pembrolizumab in locally advanced head and neck squamous cell carcinoma (LA-HNSCC), but its economic value remains uncertain.
A partitioned survival model evaluated neoadjuvant/adjuvant pembrolizumab (two 200 mg neoadjuvant cycles and fifteen 200 mg adjuvant cycles every 3 weeks) plus standard of care (surgery and postoperative radiotherapy ± cisplatin) versus open-label standard of care alone over a 30-year horizon from Chinese and US payer perspectives. Efficacy, severe adverse events (AEs; grade ≥ 3 stomatitis, cytopenias), utilities, and direct medical costs (2025 USD) were synthesized. Subgroups were stratified by PD-L1 combined positive score (CPS).
In the overall population, pembrolizumab was not cost-effective in either the US (ICER, $212,183.93/QALY) or China ($114,422.43/QALY). In the US, ICERs were $142,495.35/QALY for CPS ≥ 1 and $127,668.80/QALY for CPS ≥ 10, below the $150,000/QALY threshold, with cost-effectiveness probabilities of 57.5% and 49.2%, respectively. In China, all subgroup ICERs exceeded the $40,334/QALY threshold.
Perioperative pembrolizumab may offer economic value for selected US patients with PD-L1 CPS ≥ 1 or ≥10, although substantial decision uncertainty remains. It was not cost-effective in China or in the overall population under current pricing.
PMID:
42961801
Bibliographic data and abstract were imported from PubMed on 31 Oct 2026.
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