Cost-effectiveness of pembrolizumab plus weekly paclitaxel for PD-L1–positive platinum-resistant recurrent ovarian cancer in the United States and China

Background Pembrolizumab plus weekly paclitaxel, with or without bevacizumab, improves survival in programmed death ligand 1 (PD-L1)–positive platinum-resistant recurrent ovarian cancer, but its economic value remains uncertain. This study evaluated the cost-effectiveness of pembrolizumab plus weekly paclitaxel versus placebo plus weekly paclitaxel in patients with PD-L1 combined positive score ≥1 platinum-resistant recurrent ovarian cancer from the Chinese and United States (US) healthcare system perspectives. Methods A partitioned survival model was developed using data from ENGOT-ov65/KEYNOTE-B96. Outcomes included costs, life-years (LYs), quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), incremental net monetary benefits (INMBs), and incremental net health benefits (INHBs). Cost-effectiveness was assessed against willingness-to-pay (WTP) thresholds of $27,906/QALY in China and $150,000/QALY in the US. Deterministic and probabilistic sensitivity analyses, scenario analyses, and subgroup analyses were performed. Results In China, pembrolizumab plus weekly paclitaxel increased costs from $31,241.22 to $127,168.48 and increased outcomes from 1.57 to 2.11 LYs and from 1.02 to 1.34 QALYs, yielding 0.54 additional LYs and 0.32 additional QALYs. The ICER was $295,671.88/QALY, with an INMB of −$86,873.48 and an INHB of −3.11 QALYs. In the US, costs increased from $199,488.96 to $451,893.63, and outcomes increased from 1.59 to 2.15 LYs and from 1.03 to 1.37 QALYs. The ICER was $746,255.61/QALY, with an INMB of −$201,670.44 and an INHB of −1.34 QALYs. Pembrolizumab cost and health-state utilities were the main ICER drivers. Probabilistic sensitivity analysis showed 0% cost-effectiveness probability at both WTP thresholds. Scenario and subgroup analyses confirmed the base-case findings. At current bevacizumab prices, pembrolizumab prices would need substantial reductions to meet country-specific WTP thresholds. Conclusion Compared with placebo plus weekly paclitaxel, pembrolizumab plus weekly paclitaxel improved survival and QALYs in patients with PD-L1–positive platinum-resistant recurrent ovarian cancer but was unlikely to be cost-effective at current prices in either China or the US.