Zhou K, et al. - Using a Markov model and basic information from the KEYNOTE-042 trial, researchers compared pembrolizumab monotherapy with chemotherapy with respect to cost-effectiveness as first-line therapy in patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) with different tumor proportion scores (TPS), from perspectives of payers in China. For patients with high TPS (≥ 50%), a rise in costs by $65,322 was estimated in correlation with pembrolizumab monotherapy vs chemotherapy, with a gain of 1.79 quality adjusted life years (QALYs) for an incremental cost-effectiveness ratio (ICER) of $36,493 per QALY. Overall, they found that among different TPS populations treated with pembrolizumab monotherapy, the ICERs yield was beyond the threshold they set, three times of the Gross Domestic Product per Capita of China in 2018 ($26,508/QALY). Therefore, from the perspective of Chinese payer, pembrolizumab monotherapy vs standard chemotherapy is not a cost-effective option for patients with locally advanced or metastatic NSCLC, irrespective of TPS. Deeper discount of its current price would make pembrolizumab a preferable option.