In comparison to the US, Australia and Canada, the use of pembrolizumab for the second-line treatment of advanced bladder cancer is least cost effective in the UK.
In an analysis of cost data, published in European Urology, the incremental cost-effectiveness ratio (ICER) for pembrolizumab versus chemotherapy in the second-line treatment of advanced bladder cancer was found to be significantly higher than the NICE willingness-to-pay (WTP) threshold of £50,000.
Overall, pembrolizumab generated a gain of 0.36-0.37 quality-adjusted life-years (QALYs) compared with chemotherapy. Based on local national pay agreements a single treatment with pembrolizumab cost between 15 and 50 times more per cycle compared with chemotherapy.
In the UK, the ICER was almost £71,000 ($91,995 converted 1 September 2017) compared to ICERs in the US, Canada and Australia of $122,557/QALY, $90,099/QALY and $99,966/QALY, respectively.
Local WTP thresholds were considered to be $100,000-150,000 in the US, £20,000-50,000 in the UK, $20 000-100,000 in Canada, and $40,000-75,000 in Australia. The authors concluded that due to a higher WTP threshold, pembrolizumab could potentially be considered cost-effective in the US but not in other countries, including the UK.
The findings support the NICE decision announced last August that pembrolizumab is not cost-effective for metastatic bladder cancer due to its high cost, despite meeting end-of-life criteria.
