Cost-effectiveness analysis of PD-1 inhibitors combined with chemotherapy as first-line therapy for advanced esophageal squamous-cell carcinoma in China

Abstract

Objective: This study was aimed to investigate the cost-effectiveness of all available programmed death 1 (PD-1) inhibitors combined with chemotherapy in the first-line treatment of advanced esophageal squamous-cell carcinoma (ESCC) from the Chinese healthcare system perspective.Methods: A partitioned survival model with a 3-week cycle and a 10-year time horizon was constructed based on a network meta-analysis. The survival data and utility values were derived from clinical trials, and the direct medical costs were collected from public drug bidding database and published literature. Total costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. Scenario, one-way and probabilistic sensitivity analyses were performed to assess the uncertainty around model parameters.Results: Compared with mono-chemotherapy, toripalimab, sintilimab and camrelizumab plus chemotherapy were cost-effective treatment regimens, while serplulimab, pembrolizumab and nivolumab plus chemotherapy were not cost-effective options. Toripalimab plus chemotherapy provided the highest QALYs of 0.95 with the lower cost of $8,110.53 compared to other competing alternatives. The robustness of the base-case results was confirmed by scenario and one-way sensitivity analysis. At a willingness-to-pay threshold of three times per capita gross domestic product ($38,351.20) in 2021, the probability of toripalimab plus chemotherapy being the optimal option was 74.25% compared with other six competing alternatives.Conclusion: Toripalimab plus chemotherapy represented the most cost-effective option as the first-line therapy for advanced ESCC patients in China.

Cost-effectiveness analysis of tislelizumab plus chemotherapy as the first-line treatment for advanced or metastatic oesophageal squamous cell carcinoma in China

“…Several cost-effective results of PD-1 inhibitors combined with chemotherapy in OSCC treatment have been published [ 8 , 23 , 31 – 40 ]. A cost-effectiveness analysis was conducted to compare different PD-1 inhibitors in combination with chemotherapy for the first-line treatment of advanced OSCC in China [ 8 ]. Moreover, two studies investigated the cost-effectiveness of tislelizumab in the first-line treatment of oesophageal squamous carcinoma, which were similar to the design of our study [ 41 , 42 ].…”

“…The drug prices were derived from drug procurement platform (med.ybj.zj.gov.cn). To determine chemotherapy dosages and expenses, we assumed an average height of 165cm, weight of 65kg, and body surface area (BSA) of 1.72m 2 [ 8 ]. Our model only involved severe adverse events rated as grade≥3 that were reported in at least 5% of patients in the RATIONALE-306 trial.…”

“…One-way deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were performed to assess the robustness of the model. In DSA, drug prices were adjusted within the range of the purchase price, the cost of tislelizumab was subject to a ± 20% adjustment range because there was only one purchase price, the discount rate varied from 0 to 8% [ 30 ], and ranges for other parameters were assumed to be reasonable ranges (±20%) referring to previous publications since 95% confidence intervals (CI) was not available [ 8 , 23 ]. The impact of each input parameter on the model results was shown in the tornado diagram.…”

Cost-effectiveness analysis of serplulimab plus chemotherapy in the first-line treatment for PD-L1-positive esophageal squamous cell carcinoma in China

“…Currently, numerous studies are targeted on the economic evaluations of immunotherapies for advanced ESCC patients and warrant discussion. At the current price and WTP threshold, domestic PD-1 inhibitors, such as camrelizumab, sintilimab, tislelizumab and toripalimab, were cost-effective options as first- or second-line treatment for patients with advanced ESCC in China ( 18 , 29 , 38 – 40 ). The dynamic adjustment mechanism of the national medical insurance catalog has played a predominant role in this situation.…”

“…Health state utilities for the PFS and PD health states were estimated from patient-level EQ-5D-3L data from the RAINBOW trial due to the absence of relevant data from the ASTRUM-007 trial ( 17 ). The utility values for PFS and PD states associated with advanced ESCC were 0.75 and 0.60, respectively, have been employed in multiple economic evaluations ( 13 , 28 , 29 ). Additionally, utility decrements caused by grade 3 or above treatment-related AEs were considered by multiplying the duration-adjusted disutilities by the incidence of AEs.…”