Abstract
Background:
Adding pembrolizumab to standard concurrent chemoradiotherapy (CCRT) has shown substantial survival benefits in newly diagnosed, high-risk locally advanced cervical cancer (LACC), but its economic value in Saudi Arabia has not been established. This study assessed the cost-effectiveness of pembrolizumab plus CCRT versus placebo plus CCRT as first-line treatment for high-risk LACC from the perspective of the Saudi Arabian healthcare payer.
Methods:
A partitioned survival analysis model was developed to project lifetime costs and quality-adjusted life-years (QALYs) for a hypothetical cohort of women with high-risk LACC in the Saudi public healthcare sector, using resource use patterns consistent with major tertiary care and specialized cancer centers. Clinical efficacy data were obtained from the KEYNOTE-A18 trial. Costs were sourced from official Saudi price lists, local hospital data, and a formal Structured Expert Elicitation process, and were reported in 2025 United States dollars. Health state utilities were derived from the literature. The primary outcome was the incremental cost-effectiveness ratio. Future costs and QALYs were discounted at an annual rate of 3%. Comprehensive deterministic and probabilistic sensitivity analyses were conducted to assess uncertainty.
Results:
Adding pembrolizumab to CCRT resulted in an incremental gain of 3.51 life-years and 2.93 QALYs at an additional cost of $242,043 compared with placebo plus CCRT. At its current list price, the regimen yielded an incremental cost-effectiveness ratio of $82,626 per QALY. At a willingness-to-pay threshold of $90,000 per QALY, the probability of the pembrolizumab regimen being cost-effective was 67%.
Conclusion:
Pembrolizumab in combination with CCRT provides substantial clinical benefits in patients with high-risk LACC in Saudi Arabia. At the current price, this regimen is likely to be considered cost-effective. The analysis provides a strong, evidence-based rationale for significant price negotiations to ensure that the regimen delivers value to the Saudi healthcare system.