Evaluating Cost-Effectiveness of First-Line Cemiplimab Therapy in Advanced NSCLC

A recent cost-effectiveness analysis published in Journal of Managed Care & Specialty Pharmacy comparing cemiplimab plus chemotherapy (CCT) with pembrolizumab plus chemotherapy (PCT) as first-line treatment for advanced non-small cell lung cancer (aNSCLC) found that CCT is a dominant treatment strategy. Using a 10-year partitioned survival model informed by clinical trial data and 2024 US drug prices, the study determined that CCT not only improved quality-adjusted life-years (QALYs) but also reduced overall treatment costs compared with PCT.

Results showed that CCT had a total cost of $175 247 and yielded 1.657 QALYs, whereas PCT had a total cost of $207 926 with 1.609 QALYs, leading to an incremental cost-effectiveness ratio (ICER) of −$675 304 per QALY. Scenario and sensitivity analyses confirmed the robustness of these findings, with the cost of pembrolizumab emerging as a key driver of cost differences. Subgroup analyses further demonstrated that CCT remained a cost-effective alternative for patients with programmed cell death ligand 1(PD-L1) levels of at least 1%, while PCT was more favorable in patients with PD-L1 levels below 1%.

These findings highlight CCT as a potentially more cost-effective first-line option for aNSCLC treatment, informing formulary and clinical decision-making for payers and policymakers aiming to optimize value-based care in oncology.

“In conclusion, our findings suggested that, from the US Medicare & Medicaid payer perspective, CCT is a dominant first-line treatment option for patients with aNSCLC compared with PCT, primarily because of its lower costs and better safety profile,” researchers concluded. “Future research should reduce uncertainties by examining real-world data and exploring the subgroup and long-term effectiveness, the incidence of adverse events, and treatment costs.”

Reference

Xue X, Ngorsuraches S, Johnson B, Zheng J, Qian J. Cost-effectiveness of cemiplimab plus chemotherapy vs pembrolizumab plus chemotherapy as first-line treatment for advanced non-small cell lung cancer. J Manag Care Spec Pharm. 2025;31(2):137-146. doi:10.18553/jmcp.2025.31.2.137