Cost-Effectiveness of Perioperative Pembrolizumab in Head and Neck Cancer: Impact of PD-L1 Expression Levels

KEYNOTE-689 trial showed perioperative pembrolizumab enhances event-free survival in locally advanced head and neck squamous cell carcinoma (HNSCC).
Cost-effectiveness analysis reveals pembrolizumab is economically viable only in patients with PD-L1 combined positive score (CPS) greater than 10.
Subgroup with CPS 1 to 10 exhibits marginal health gains at high incremental costs, limiting economic justification.
Biomarker-driven stratification can guide value-based use of immunotherapy in HNSCC treatment protocols.