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

Abstract

ObjectiveThe ASTRUM-007 trial (NCT03958890) demonstrated that serplulimab plus chemotherapy administered every 2-week significantly improved progression-free and overall survival in patients with previously untreated, programmed death-ligand 1 (PD-L1) positive advanced esophageal squamous-cell carcinoma (ESCC). This study was aimed to investigate the cost-effectiveness of serplulimab plus chemotherapy in the first-line treatment of PD-L1-positive advanced ESCC.MethodsA partitioned survival model with a 2-week cycle and a 10-year time horizon was constructed from the Chinese healthcare system perspective. The survival data, direct medical costs and utilities were derived from the ASTRUM-007 trial, YAOZHI database and published sources. 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.ResultsCompared with chemotherapy, serplulimab plus chemotherapy provided additional 0.27 QALYs with an incremental cost of $33,460.86, which had an ICER of $124,483.07 per QALY. The subgroup analyses revealed that the ICERs of serplulimab plus chemotherapy were $134,637.42 and $105,589.71 in advanced ESCC patients with 1 ≤ CPS < 10 and CPS ≥ 10, respectively. The price of serplulimab, patient weight, utility values and discount rate were the most influential parameters on base-case results. At a willingness-to-pay threshold of three times per capita GDP ($40,587.59) in 2022, the probability of serplulimab plus chemotherapy being cost-effective was 0% compared with chemotherapy. When the price of serplulimab decreased by 70%, the probabilities of serplulimab plus chemotherapy being cost-effective were 81.42%, 67.74% and 96.75% in advanced ESCC patients with PD-L1-positive, PD-L1 1≤CPS<10 and CPS≥10, respectively.ConclusionSerplulimab plus chemotherapy in the first-line treatment for PD-L1-positive advanced ESCC might not be cost-effective in China.

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

“…The economics of PD-1 inhibitors for OSCC treatment are also receiving increasing attention. Several cost-effective results of PD-1 inhibitors combined with chemotherapy in OSCC treatment have been published [8,23,[31][32][33][34][35][36][37][38][39][40]. A cost-effectiveness analysis was conducted to compare different PD-1 inhibitors in combination with chemotherapy for the firstline treatment of advanced OSCC in China [8].…”

Immune checkpoint inhibitors versus chemotherapy as second-line therapy for advanced oesophageal squamous cell carcinoma: a systematic review and economic evaluation

“…To calculate the dosages of chemotherapies, the default body weight of 65.0 kg and body surface area of 1.72 m 2 were assumed for Chinese patients. 45 Health state utilities associated with OSCC were unavailable in the included trials; thus, we used those from the RAINBOW trial considering their comparability. 46 The disutility values incurred for treatment-related AEs were obtained from the literature.…”

Cost-effectiveness of immunotherapies for advanced squamous non-small cell lung cancer: a systematic review

“…In addition, with ICER between $333,199 to $670,309.66 per QALY, the cost-effectiveness of atezolizumab, also a first-line treatment for LSCC, has been negated by both US and Chinese studies, and price reductions have been suggested [ 36 – 38 ]. Most of the published reviews in this area have targeted patients with non-small cell lung cancer [ 28 ] and have focused on a specific region [ 39 ] or comparison of two specific therapies [ 40 ]. Therefore, no studies have simultaneously compared the cost-effectiveness of all the immunotherapies in patients with LSCC.…”