Cost-Effectiveness Analysis of Pembrolizumab Plus Chemotherapy vs. Chemotherapy Alone as First-Line Treatment in Patients With Esophageal Squamous Cell Carcinoma and PD-L1 CPS of 10 or More

Abstract

BackgroundThis study aimed to analyze the economics of pembrolizumab plus chemotherapy as first-line treatment in patients with esophageal squamous cell carcinoma (ESCC) and programmed cell death-Ligand 1 (PD-L1) combined positive score (CPS) of 10 or more in China.MethodsBased on the advanced ESCC of the KEYNOTE-590 clinical trial data, a Markov model was performed to simulate the clinical course and evaluate the patient's total lifetime, total costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) for pembrolizumab plus chemotherapy (cisplatin and 5-fluorouracil) vs. chemotherapy alone in first-line treatment of ESCC and PD-L1 CPS of 10 or more. Utility values and direct costs related to the treatments were gathered from the published literature data. One-way and probabilistic sensitivity analyses were conducted to check the stability of the model.ResultsThe baseline analysis indicated that the incremental effectiveness and cost of pembrolizumab plus chemotherapy vs. chemotherapy alone added 1.23 QALYs and resulted in an incremental cost of $51,320.22, which had an ICER of $41,805.12/QALY, higher than the willingness-to-pay (WTP) threshold of China ($37,663.26/QALY). The sensitivity analysis demonstrated that the ICERs were most sensitive to the cycle of pembrolizumab used and the cost of pembrolizumab.ConclusionThe result of our present analysis suggests that the addition of pembrolizumab plus chemotherapy as first-line treatment might not be cost-effective for patients with ESCC and PD-L1 CPS of 10 or more in China.

Cost-effectiveness of sintilimab plus chemotherapy versus chemotherapy alone as first-line treatment of locally advanced or metastatic oesophageal squamous cell carcinoma

“…( 29 ) and Zheng et al. ( 30 ) investigated the cost-effectiveness of pembrolizumab plus chemotherapy vs placebo plus chemotherapy in the first-line therapy of oesophageal cancer patients in China, and also obtained results contrary to the current study with ICERs of $115,391.84/QALY and $41,805.12/QALY, respectively, exceeding the threshold of WTP. These opposite results to ours maybe owing to different trial data and survival curve simulation techniques and different costs of PD-1 inhibitors, leading to various incremental costs and QALYs.…”

Cost-effectiveness analysis of serplulimab in combination with cisplatin plus 5-fluorouracil chemotherapy compared to cisplatin plus 5-fluorouracil chemotherapy as first-line treatment for advanced or metastatic esophageal squamous cell carcinoma in China

“…Health economists have reported economic analysis reports based on Markov models or partition survival models for these three trials. 26–28 The research results show that using three times China’s per capita GDP as the WTP threshold, pembrolizumab, camrelizumab, or toripalimab combined with chemotherapy are not cost-effective alternative treatments to chemotherapy. Although the KEYNOTE-590, ESCORT-1st, and JUPITER-06 clinical trials have many similarities with the ASTRUM-007 trial and the cost-effectiveness analysis results are consistent with our research results, it seems that serplulimab combined with chemotherapy may not be an economic alternative to chemotherapy alone.…”

“…[37][38][39][40] Therefore, our model determined the utility score for PFS to be 0.74, the utility score for progression disease (PD) to be 0.58, and the utility score for mortality to be 0. [24][25][26] Additionally, we have considered the negative impact of treatment-related AEs of grade 3 or higher with an incidence greater than 5% on patient quality of life, which could lead to negative utility scores. [26][27][28] The main utility parameters are shown in Table 1.…”

“…The model's main outputs were cost, qualityadjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs). 24 Lin et al, 25 Zheng et al 26 Progressive disease 0.58 0.46 0.70 Beta Wu et al, 24 Lin et al, 25 Zheng et al 26 Anemia −0.0028 −0.0023 −0.0034 Beta Zheng et al 26 Xu et al, 27 Zhang et al 28 Neutrophil count decreased −0.0035 −0.0028 −0.0041 Beta Zheng et al 26 Xu et al, 27 Zhang et al 28 White blood cell count decreased −0.0035 −0.0028 −0.0041 Beta Zheng et al 26 Xu et al, 27 We simulated real-world drug administration and calculated the costs of preventive administration, hospitalization, nursing, and drug infusion. We rounded the amount of medication used up to the nearest vial since the remaining infusion drugs during administration must be recovered and destroyed rather than being administered to the next patient.…”

“…[24][25][26] Additionally, we have considered the negative impact of treatment-related AEs of grade 3 or higher with an incidence greater than 5% on patient quality of life, which could lead to negative utility scores. [26][27][28] The main utility parameters are shown in Table 1.…”