---
title: "Cost-effectiveness of pembrolizumab (neoadjuvant + adjuvant) for resectable LA HNSCC in Switzerland"
id: "pubmed-42565346"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42565346"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42565346/"
doi: "10.1080/13696998.2026.2712763"
published_at: "2026-08-07T12:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Cost-effectiveness of pembrolizumab (neoadjuvant + adjuvant) for resectable LA HNSCC in Switzerland
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42565346
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42565346/)
- **DOI:** [10.1080/13696998.2026.2712763](https://doi.org/10.1080%2F13696998.2026.2712763)
- **Published At:** 2026-08-07T12:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The study assessed the **cost-effectiveness** of neoadjuvant pembrolizumab followed by adjuvant pembrolizumab plus standard of care (NP/AP + SOC) versus SOC alone for stage III–IVA resectable locally advanced head and neck squamous cell carcinoma (**LA HNSCC**) from a Swiss healthcare perspective. - Efficacy inputs were taken from patient-level data of the KEYNOTE-689 randomized trial and extrapolated using parametric survival analysis. - A 4-state Markov cohort model originally developed for the US was adapted to Swiss inputs; health-state utilities were derived from EuroQoL-5D collected in KEYNOTE-689. - Costs were expressed in 2025 Swiss francs (CHF) and obtained from national tariffs and Swiss clinical experts; a 3.0% discount rate was applied to costs and outcomes in the base case. - Over a lifetime horizon, NP/AP + SOC increased life expectancy by **1.81 years** and produced an incremental **1.42 QALYs** compared with SOC. - Total mean costs were CHF 172,086 for NP/AP + SOC versus CHF 151,908 for SOC, an incremental cost of CHF 20,178 per patient. - The incremental cost-effectiveness ratio (**ICER**) was CHF **14,227 per QALY** gained and CHF 11,130 per life-year (LY) gained. - At a hypothetical willingness-to-pay (WTP) threshold of CHF 100,000 per QALY, NP/AP + SOC had a **96% probability** of being cost-effective. - Sensitivity analyses included deterministic, probabilistic, and scenario analyses to assess robustness; key uncertainties included extrapolation of long-term outcomes and Swiss-specific data gaps. - Limitations reported: median follow-up of 3.2 years required extrapolation; lack of real-world Swiss cost data necessitated reliance on expert opinion; Swiss-specific utility values were unavailable so Belgian utilities were used. - Authors conclude NP/AP + SOC is cost-effective in Switzerland and supportive of clinical implementation for eligible LA HNSCC patients, based on the modelled results and assumed WTP threshold.
## Clinical Analysis & Structured Key Points
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Epub 2026 Aug 7. # Cost-effectiveness of pembrolizumab as neoadjuvant therapy and in combination with standard of care (SOC) as adjuvant therapy for stage III-IVA resectable locally advanced head and neck squamous cell carcinoma (LA HNSCC) in Switzerland [Claudine Bommer](https://pubmed.ncbi.nlm.nih.gov/?term=Bommer+C&cauthor_id=42565346)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42565346/#full-view-affiliation-1 "External Affairs and Market Access, MSD, Lucerne, Switzerland."), [Srushti Gotarkar](https://pubmed.ncbi.nlm.nih.gov/?term=Gotarkar+S&cauthor_id=42565346)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42565346/#full-view-affiliation-2 "HEDS Regional Team, Merck & Co., Inc., Rahway, NJ, USA."), [Burcu Akyol](https://pubmed.ncbi.nlm.nih.gov/?term=Akyol+B&cauthor_id=42565346)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42565346/#full-view-affiliation-3 "Patient Access and Corporate Affairs, MSD, Istanbul, Türkiye."), [Kian Farajkhah](https://pubmed.ncbi.nlm.nih.gov/?term=Farajkhah+K&cauthor_id=42565346)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42565346/#full-view-affiliation-2 "HEDS Regional Team, Merck & Co., Inc., Rahway, NJ, USA."), [Dzhumber Ugrekhelidze](https://pubmed.ncbi.nlm.nih.gov/?term=Ugrekhelidze+D&cauthor_id=42565346)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42565346/#full-view-affiliation-4 "Health Economics and Decision Sciences, MSD, Zurich, Switzerland."), [Sarah Sharon Gabriel](https://pubmed.ncbi.nlm.nih.gov/?term=Gabriel+SS&cauthor_id=42565346)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42565346/#full-view-affiliation-5 "Medical Affairs, MSD, Lucerne, Switzerland."), [Feng Qian](https://pubmed.ncbi.nlm.nih.gov/?term=Qian+F&cauthor_id=42565346)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42565346/#full-view-affiliation-2 "HEDS Regional Team, Merck & Co., Inc., Rahway, NJ, USA.") Affiliations Expand ### Affiliations * 1 External Affairs and Market Access, MSD, Lucerne, Switzerland. * 2 HEDS Regional Team, Merck & Co., Inc., Rahway, NJ, USA. * 3 Patient Access and Corporate Affairs, MSD, Istanbul, Türkiye. * 4 Health Economics and Decision Sciences, MSD, Zurich, Switzerland. * 5 Medical Affairs, MSD, Lucerne, Switzerland. * PMID: **42565346** * DOI: [ 10.1080/13696998.2026.2712763 ](https://doi.org/10.1080/13696998.2026.2712763) Item in Clipboard # Cost-effectiveness of pembrolizumab as neoadjuvant therapy and in combination with standard of care (SOC) as adjuvant therapy for stage III-IVA resectable locally advanced head and neck squamous cell carcinoma (LA HNSCC) in Switzerland Claudine Bommer et al. J Med Econ. 2026 Dec. Show details Display options Display options Format Abstract PubMed PMID J Med Econ Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Med+Econ%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Med+Econ%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42565346/) . 2026 Dec;29(1):2121-2134. doi: 10.1080/13696998.2026.2712763. Epub 2026 Aug 7. ### Authors [Claudine Bommer](https://pubmed.ncbi.nlm.nih.gov/?term=Bommer+C&cauthor_id=42565346)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42565346/#short-view-affiliation-1 "External Affairs and Market Access, MSD, Lucerne, Switzerland."), [Srushti Gotarkar](https://pubmed.ncbi.nlm.nih.gov/?term=Gotarkar+S&cauthor_id=42565346)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42565346/#short-view-affiliation-2 "HEDS Regional Team, Merck & Co., Inc., Rahway, NJ, USA."), [Burcu Akyol](https://pubmed.ncbi.nlm.nih.gov/?term=Akyol+B&cauthor_id=42565346)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42565346/#short-view-affiliation-3 "Patient Access and Corporate Affairs, MSD, Istanbul, Türkiye."), [Kian Farajkhah](https://pubmed.ncbi.nlm.nih.gov/?term=Farajkhah+K&cauthor_id=42565346)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42565346/#short-view-affiliation-2 "HEDS Regional Team, Merck & Co., Inc., Rahway, NJ, USA."), [Dzhumber Ugrekhelidze](https://pubmed.ncbi.nlm.nih.gov/?term=Ugrekhelidze+D&cauthor_id=42565346)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42565346/#short-view-affiliation-4 "Health Economics and Decision Sciences, MSD, Zurich, Switzerland."), [Sarah Sharon Gabriel](https://pubmed.ncbi.nlm.nih.gov/?term=Gabriel+SS&cauthor_id=42565346)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42565346/#short-view-affiliation-5 "Medical Affairs, MSD, Lucerne, Switzerland."), [Feng Qian](https://pubmed.ncbi.nlm.nih.gov/?term=Qian+F&cauthor_id=42565346)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42565346/#short-view-affiliation-2 "HEDS Regional Team, Merck & Co., Inc., Rahway, NJ, USA.") ### Affiliations * 1 External Affairs and Market Access, MSD, Lucerne, Switzerland. * 2 HEDS Regional Team, Merck & Co., Inc., Rahway, NJ, USA. * 3 Patient Access and Corporate Affairs, MSD, Istanbul, Türkiye. * 4 Health Economics and Decision Sciences, MSD, Zurich, Switzerland. * 5 Medical Affairs, MSD, Lucerne, Switzerland. * PMID: **42565346** * DOI: [ 10.1080/13696998.2026.2712763 ](https://doi.org/10.1080/13696998.2026.2712763) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **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. **Keywords:** Cost-effectiveness; I00; I10; I11; I18; head and neck cancer; head and neck squamous cell carcinoma; model; pembrolizumab. 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