No abstract

Purpose. This study aimed to assess the cost-effectiveness of neoadjuvant therapy in combination with surgery and adjuvant therapy compared with either surgery alone or surgery plus adjuvant therapy for the treatment of neuroendocrine cervical tumors (NETs). Materials and methods. A single-institution retrospective analysis of 107 patients with NETs was performed based on the new International Federation of Gynecology and Obstetrics (FIGO 2018) staging system. We divided the patients who underwent radical surgery into two groups: neoadjuvant therapy (NACT) and non-neoadjuvant therapy (non-NACT) groups. We performed subgroup analysis of overall survival and cost-effectiveness by dividing the patients with stage I-IV disease into four subgroups. An assessment was constructed to reflect the costs and effectiveness of the treatment from the perspectives of both clinical practice and health economics.Results. The NACT group had -0.45 life-years (LYs) at an incremental cost of $15197.58, compared with the non-NACT group, which means that it is not cost-effective. However, subgroup analysis of patients with stage II disease showed that the NACT group had significantly better overall survival time than the non-NACT group (median overall survival had not been reached versus 29.23 months, p＜0.001). The NACT group had an incremental cost-effectiveness ratio (ICER) of $5921.43/LY compared with the non-NACT group for stage II disease. Probabilistic sensitivity analyses showed that when the willingness-to-pay (WTP) threshold reached $31118.29/LY, which is nearly three times China's per capita GDP 2020, the probability of NACT being cost-effective was 97% versus non-NACT group in the treatment of stage II neuroendocrine tumors of the uterine cervix. Conclusion. NACT is not a cost-effective treatment strategy compared with non-NACT in the treatment of NETs, but may be a cost-effective treatment option for stage II NETs.

This study aimed to evaluate and compare nivolumab's cost-effectiveness with chemotherapy in patients with advanced esophageal squamous cell carcinoma from the Chinese healthcare system perspective. To this end, the researchers utilized a partitioned survival model with three mutually exclusive health stages. The characteristics of the patients used as inclusion and exclusion criteria in this model were the same as those used for patients with advanced esophageal squamous cell carcinoma in the ATTRACTION-3 study. The ATTRACTION-3 trial, which took place between January 7, 2016 and November 12, 2018, also yielded important clinical data. Data on medical and economic preferences were collected from real-world clinical practices. Costs, quality-adjusted life years, and incremental cost-effectiveness ratio were calculated for the two therapy options. The model uncertainty was investigated using a deterministic and probabilistic sensitivity analysis. When compared to chemotherapy, nivolumab was linked with an increase of 0.28 quality-adjusted life years with an increased cost of US$ 36,956.81 per patient in the base case analysis of a hypothetical sample of 419 patients. The incremental cost-effectiveness ratio in the deterministic sensitivity analysis was US$ 132,029.46/quality-adjusted life year, with a 48.02% probability of being cost-effective at willingness-to-pay thresholds of US$ 132,029.22/quality-adjusted life year. The incremental cost-effectiveness ratio remained greater than US$ 80,000/quality-adjusted life year in the deterministic sensitivity analyses. To be more cost-effective and remain below the threshold of 37,653 US$/quality-adjusted life year, which the Chinese population can afford, nivolumab's price would have to be lowered sharply by 53.50%. Nivolumab is clinically beneficial but not cost-effective when compared to chemotherapy. A substantial reduction in nivolumab's drug acquisition cost would be necessary to make it cost-effective for immunotherapy.