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Neoplasm Staging / Head and Neck Neoplasms / Head and Neck Cancer · Journal article
Journal of Medical Economics · August 7, 2026
Well-designed and adequately powered for the question it asks.
Neoadjuvant and adjuvant pembrolizumab combined with standard of care is cost-effective for stage III-IVA resectable LA HNSCC in Switzerland, with an ICER of CHF 14,227/QALY well below the CHF 100,000/QALY threshold and a 96% probability of cost-effectiveness. The analysis extrapolates efficacy from the pivotal KEYNOTE-689 RCT using a Markov model adapted to Swiss healthcare costs and utilities.
Cost-effectiveness analysis using a 4-state Markov cohort model. Patients with stage III-IVA resectable locoregionally advanced head and neck squamous cell carcinoma modelled using patient-level data from KEYNOTE-689. Intervention: Neoadjuvant pembrolizumab followed by adjuvant pembrolizumab plus standard of care (NP/AP + SOC). Compared with: Standard of care (SOC) alone. Swiss healthcare perspective; analysis adapted from US-specific model.
NP/AP + SOC extended life expectancy by 1.81 years versus SOC alone Incremental QALYs of 1.42 with NP/AP + SOC compared to SOC ICER of CHF 14,227/QALY gained and CHF 11,130/LY gained for NP/AP + SOC
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
The cost-effectiveness of pembrolizumab-based neoadjuvant and adjuvant therapy is well-established in this population, supporting reimbursement and clinical implementation in Switzerland. Clinicians should be aware that the long-term extrapolation relies on 3.2 years of trial data and Swiss cost estimates are modelled rather than empirically derived.
A rigorous health economic analysis based on a pivotal Phase 3 RCT (KEYNOTE-689) with clear cost-effectiveness results well below the Swiss willingness-to-pay threshold, though grounded in modelling rather than direct trial cost outcomes.
As stated by the source record.
Quoted from the source exactly as published.
The cost-effectiveness of pembrolizumab-based neoadjuvant and adjuvant therapy is well-established in this population, supporting reimbursement and clinical implementation in Switzerland. Clinicians should be aware that the long-term extrapolation relies on 3.2 years of trial data and Swiss cost estimates are modelled rather than empirically derived.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Aims. KEYNOTE-689 trial results demonstrated that neoadjuvant pembrolizumab followed by adjuvant pembrolizumab plus standard of care (NP/AP + SOC) significantly improved event-free survival (EFS) versus SOC alone in patients with locoregionally advanced head and neck squamous cell carcinoma (LA HNSCC). This study evaluated the cost-effectiveness of NP/AP + SOC vs. SOC from the Swiss healthcare perspective.Materials and methods. A 4 mutually exclusive health state US-specific Markov cohort model was adapted to the Swiss healthcare perspective. Efficacy inputs were derived from patient-level KEYNOTE-689 data using parametric survival analysis. Healthcare resource utilisation and costs (2025 Swiss Franc [CHF]) were obtained from Swiss clinical experts and national tariffs. Health state utilities were derived from EuroQoL-5 dimension data collected in KEYNOTE-689. Outcomes included costs, quality-adjusted life-years (QALYs) and life-years (LYs), measured over a lifetime horizon. At the base-case, a 3.0% discount rate was applied to costs and effectiveness. Cost-effectiveness was evaluated as an incremental cost-effectiveness ratio (ICER) at a hypothetical willingness-to-pay (WTP) threshold of CHF 100,000/QALY gained. Deterministic, probabilistic, and scenario analyses were conducted for sensitivity.Results. NP/AP + SOC treatment extended life expectancy by 1.81 years compared to SOC, generating 1.42 incremental QALYs. Total costs were CHF 172,086 for NP/AP + SOC versus CHF 151,908 for SOC, resulting in incremental costs of CHF 20,178/patient. ICERs were CHF 14,227/QALY gained and CHF 11,130/LY gained. At a WTP of CHF 100,000/QALY gained, NP/AP + SOC had a 96% probability of being cost-effective.Limitations. Long-term follow-up data (median 3.2 years) required extrapolation; real-world Swiss cost data were unavailable necessitating expert opinion; Belgian utility values were used as Swiss-specific data were unavailable.Conclusion. NP/AP + SOC is cost-effective for LA HNSCC in Switzerland, supporting clinical implementation.
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