Cost-Effectiveness of Pembrolizumab in Advanced Endometrial Cancer: A Systematic Review Publisher



Sargazi N ; Afshari S ; Nahvijou A ; Daroudi R ; Hashemi FA ; Nasehi MM ; Shahali Z ; Takian A
Source: Gynecologic Oncology Published:2026

Abstract

Objective: Pembrolizumab is highly effective for advanced endometrial cancer (AEC), but its high cost imposes a substantial financial burden. This systematic review aims to evaluate the cost-effectiveness (CE) of pembrolizumab in AEC to provide evidence for informed resource allocation. Methods: We performed a comprehensive search of Scopus, Web of Science, PubMed, Embase, and the Cochrane Library for studies published between January 1, 2000, and July 18, 2025. We assessed the quality of the included studies using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) checklist. Results: We included a total of 19 studies, and assessed the majority (n = 17, 89%) as good quality. Most studies were conducted from a payer's perspective using a lifetime time horizon in high income countries. 17 studies (89%) used cost-effectiveness analysis (CEA), with outcomes primarily reported as an incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) (94%). Pembrolizumab-based interventions were reported as cost-effective in ten studies (53%). Conclusions: This review found pembrolizumab's CE is tied to a nation's economic capacity and clinical context. High drug costs remain a primary barrier. Achieving equitable cancer care requires strategic price negotiations and further research on implementation in low-resource settings. © 2026 Elsevier Inc.