Libtayo “more favorable” than Keytruda for first-line treatment of advanced NSCLC, study finds

Although immunotherapy has been a major advance in the 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 revealed 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 of health outcomes research and policy at Auburn University's Harrison College of Pharmacy in Auburn, Alabama.

The FDA approved Libtayo 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 U.S. 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.”

With lung cancer claiming over 127,000 lives each year in the U.S., finding cost-effective treatment options has never been more urgent. At the same time, lung cancer is one oncology's recent success stories because of immunotherapy and other treatment advances. The five-year survival of localized NSCLC is now 67%.

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