Cost-Effectiveness Study: Libtayo “More Favorable” Than Keytruda for First-Line Treatment of Advanced NSCLC

Although immunotherapy has been a game-changer for the treatment of advanced non–small cell lung cancer (NSCLC), it comes with a hefty price tag. As new therapies emerge, balancing clinical effectiveness with financial sustainability has become a critical focus for healthcare providers and policymakers alike.

Now, a new analysis, published this month in the Journal of Managed Care & Specialty Pharmacy, has shown that that Libtayo (cemiplimab) plus chemotherapy (“CCT”) could be a more cost-effective option than the standard Keytruda (pembrolizumab) plus chemotherapy (“PCT”). The study was conducted by a group of researchers including Jingjing Qian, Ph.D., an associate professor at Auburn University.

Libtayo (pronounced lib-TIE-oh) is a programmed death receptor1 (PD-1) blocking antibody that was first approved by the FDA in 2018 as a treatment for metastatic cutaneous squamous cell carcinoma (CSCC) or locally advanced CSCC. It was subsequently approved by the FDA in 2022 as a first-line treatment for advanced NSCLC, in combination with chemotherapy. However, it has been unclear whether this new combination treatment could outperform Keytruda plus chemotherapy from a cost-effectiveness standpoint. This prompted researchers to assess the two treatments using a model with a 10-year horizon, drawing on data from the EMPOWER-Lung 3, KEYNOTE-407, and KEYNOTE-189 clinical trials. Costs and quality of life metrics were based on U.S. payer prices from 2024, with the study evaluating total costs, quality-adjusted life-years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER).

The study’s base-case analysis revealed that PCT had a total cost of $207,926, with 1.609 QALYs. In contrast, CCT had a lower total cost of $175,247, providing 1.657 QALYs. The ICER for CCT was −$675,304 per QALY. This indicates that for every additional QALY gained, CCT costs less than PCT.

Scenario analyses further supported these findings, with CCT proving cost-effective 96.9% of the time when the willingness-to-pay threshold was set at $150,000 per QALY. Subgroup analyses showed that CCT remained the favorable option for patients with biomarker PD-L1 levels of at least 1%, reinforcing its value across different patient profiles.

“Our findings demonstrated that CCT [Libtayo + chemotherapy], as a first-line treatment for patients with NSCLC, results in lower cost and higher QALYs than PCT [Keytruda + chemotherapy] from the US Medicare & Medicaid payer perspective,” the study authors wrote in their paper. They explained that the “results were mainly driven by the lower cost of cemiplimab [Libtayo] compared with pembrolizumab [Keytruda] and the superior safety profile of CCT compared with PCT.”

According to American Cancer Society projections, approximately 225,000 people in the U.S. will be diagnosed with lung cancer in 2025, and the vast majority (nearly 90%) will be NSCLC. Lung cancer mortality has been falling since the 1990s for men and since the early 2000s for women due to the fewer people smoking, according to the cancer society, but the cancer society credits treatment advances for NSCLC with recent mortality declines.

Libtayo and other immunotherapic agents are among those treatment advances. But as Qian and her colleagues note, immunotherapy is expensive. Citing that figures reported in Oncology Nursing News, they say that the average drug cost (total cost paid by payers and patients) for patients undergoing immunotherapy was $132,582 per year compared with the average drug cost of $26,095 per year for patients with cancer not receiving immunotherapy in the United States.

“From a cost-effectiveness perspective, cemiplimab plus chemotherapy could be a more favorable treatment option for advanced NSCLC compared with pembrolizumab plus chemotherapy,” Qian and her colleagues wrote. “Our findings inform clinicians and policymakers in clinical and formulary decision-making in optimizing first-line treatment strategies for patients with advanced NSCLC.”