Study: Libtayo is a Cost-effective Treatment in Advanced Skin Cancer vs. Keytruda

In advanced cutaneous squamous cell carcinoma, Libtayo (cemiplimab-rwlc) is a cost-effective treatment choice compared with Keytruda (pembrolizumab), according to a new study in the Journal of Managed Care + Specialty Pharmacy.

The study found that Libtayo resulted in an incremental gain of 3.44 life-years and an incremental cost-effectiveness ratio of $130,329 per quality-adjusted life-year (QALY) versus Merck’s Keytruda.

Quality-adjusted life year is considered the gold standard for measuring how well a medical treatment improves and lengthens patients’ lives and serves as a fundamental component of cost-effectiveness analyses, according to the Institute for Clinical and Economic Review. The Institute recommends a threshold of $100,000 to $150,000/QALY.

At a willingness-to-pay threshold of $150,000/QALY, probabilistic sensitivity analyses (a technique used to measure confidence in the analysis) indicated a 71% probability that Libtayo is cost-effective when compared with Keytruda.

Libtayo was approved in September 2018 and Keytruda in June 2020 to treat patients with advanced cutaneous squamous cell carcinoma. Before the availability of immunotherapy, patients with this cancer often had a poor prognosis.

Investigators used a “partitioned survival” cost-effectiveness model, which is commonly used in health technology assessments of advanced cancer therapies. Clinical efficacy for Libtayo was based on the EMPOWR-CSCC-1 study, as well as a literature search. For Keytruda, investigators used two phase 2 trials (KEYNOTE-629 and CARSKIN). Because cost-effectiveness evaluation requires a lifetime time horizon, investigators used the Guyot algorithm to reconstruct the progression-free survival and overall survival for each of these studies.

Costs included drug acquisition, drug administration, disease management, terminal care, and adverse events and were based on published 2020 U.S. list prices.

But investigators cautioned that there was no head-to-head trial of Libtayo versus Keytruda in advanced cutaneous squamous cell carcinoma to inform treatment effects in this cost-effectiveness model. Population-adjusted indirect comparisons were used to account for the differences in populations included in the clinical efficacy trials.

The study was sponsored by Regeneron and Sanofi, who jointly developed Libtayo.