Cost-effectiveness analysis of nivolumab combination therapy in the first-line treatment for advanced esophageal squamous-cell carcinoma

Abstract

ObjectiveWe aimed to investigate the cost-effectiveness of nivolumab plus chemotherapy and nivolumab plus ipilimumab versus chemotherapy in the first-line treatment for advanced esophageal squamous-cell carcinoma (ESCC) patients from a healthcare system perspective in China.MethodsOn the basis of the CheckMate 648 trial, a partitioned survival model was constructed to estimate economic costs and health outcomes among overall and PD-L1-positive advanced ESCC patients over a 10-year lifetime horizon. The health-related costs and utilities were obtained from the local charges and published literature. The lifetime costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) were measured. One-way and probabilistic sensitivity analyses (PSA) were performed to assess the robustness of the model.ResultsIn the base-case analysis, in overall and PD-L1-positive advanced ESCC patients, the ICERs were $415,163.81/QALY and $216,628.00/QALY for nivolumab plus chemotherapy, and$430,704.11/QALY and $185,483.94/QALY for nivolumab plus ipilimumab, respectively, compared with chemotherapy. One-way sensitivity analyses revealed that patients’ weight was the most influential parameter on ICER. The PSA demonstrated that the probability of nivolumab combination therapy being cost-effective was 0% over chemotherapy at the current price and willingness-to-pay threshold ($38,351.20/QALY). When the price of nivolumab and ipilimumab decreased 80%, the cost-effective probability of nivolumab plus ipilimumab increased to 40.44% and 86.38% in overall and PD-L1-positive advanced ESCC patients, respectively.ConclusionNivolumab combination therapy could improve survival time and health benefits over chemotherapy for advanced ESCC patients, but it is unlikely to be a cost-effective treatment option in China.

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

“…Health state utilities were estimated based on the EuroQoL fivedimension, three-level questionnaire reported from a double-blind, randomised phase 3 trial, which recruited participants with metastatic or locally advanced gastric or gastro-oesophageal junction adenocarcinoma (Wilke et al, 2014). The baseline utility values for PFS and PD states were 0.75 and 0.60, respectively, which were in compliance with previously published cost-effectiveness analyses (Yang et al, 2021;Liu et al, 2022). The disutility values caused by grade 3 or above treatment-related AEs were considered by multiplying the duration-adjusted disutilities by the prevalence rates of specific AEs (Lloyd et al, 2006;Nafees et al, 2017;Cai et al, 2021;Shao et al, 2022) (Table 2).…”

“…To estimate drug costs, we calculated the average winning bids in 2023 from YAOZHI database (https://data.yaozh.com/), which aggregated the latest price data around the country. The default height of 165 cm and body weight of 65 kg, with an average body surface area (BSA) of 1.72 m 2 were assumed for the Chinese ESCC patients to determine the dosage and expenditure of chemotherapies (Liu et al, 2022). Other healthcare-related costs were retrieved from recently Frontiers in Pharmacology frontiersin.org published literature (Liu et al, 2022;.…”

“…The default height of 165 cm and body weight of 65 kg, with an average body surface area (BSA) of 1.72 m 2 were assumed for the Chinese ESCC patients to determine the dosage and expenditure of chemotherapies (Liu et al, 2022). Other healthcare-related costs were retrieved from recently Frontiers in Pharmacology frontiersin.org published literature (Liu et al, 2022;. Grade 3 or above AEs with an incidence of greater than 5% reported in the clinical trial were included as they exerted a considerable effect on the course of survival and treatment, including anemia, neutropenia, leukopenia, stomatitis, nausea, fatigue, vomiting, hyponatraemia, hypokalemia and pneumonia (Liu et al, 2022;Shao et al, 2022;Zhan et al, 2022).…”

“…Other healthcare-related costs were retrieved from recently Frontiers in Pharmacology frontiersin.org published literature (Liu et al, 2022;. Grade 3 or above AEs with an incidence of greater than 5% reported in the clinical trial were included as they exerted a considerable effect on the course of survival and treatment, including anemia, neutropenia, leukopenia, stomatitis, nausea, fatigue, vomiting, hyponatraemia, hypokalemia and pneumonia (Liu et al, 2022;Shao et al, 2022;Zhan et al, 2022). For each treatment regimen, the management cost of serious AEs were determined by multiplying the unite cost (per event) by the corresponding incidence rate.…”

“…Most published economic evaluations have assessed the costeffectiveness of camrelizumab (Zhang et al, 2021), nivolumab (Liu et al, 2022), pembrolizumab (Zhu et al, 2022a) and sintilimab (Ye et al, 2022) compared to chemotherapy in the first-line setting for advanced ESCC. However, the cost-effectiveness between all available first-line chemoimmunotherapies for patients with advanced ESCC was still uncertain.…”