Cost-effectiveness analysis of pembrolizumab versus chemotherapy for microsatellite instability-high or mismatch repair-deficient metastatic colorectal cancer

Liu, Tong; Liu, Shuang; Guan, Shangwei; Tai, Yu Tzu; Jin, Yao; Dong, Mei

doi:10.1080/1120009x.2022.2162220

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…To the best of our knowledge, there have been four modelling studies also investigating the cost-effectiveness of PD-1 inhibitors for the treatment of MSI-H/dMMR CRC (36)(37)(38)(39). These four studies were conducted in the US and China context, in general, PD-1 inhibitors were cost-effective, which were consistent with our findings.…”

Section: Main Findingssupporting

confidence: 89%

“…These four studies were conducted in the US and China context, in general, PD-1 inhibitors were cost-effective, which were consistent with our findings. Specifically, pembrolizumab was cost-effective both in firstand second-line due to superiority of efficacy compared with chemotherapy (37)(38)(39). In addition, in the study comparing ipilimumab plus nivolumab, nivolumab alone and chemotherapy, ICIs were not cost-effective in the base-case analysis due to their high price.…”

Section: Main Findingsmentioning

confidence: 99%

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The cost-effectiveness analysis of serplulimab versus regorafenib for treating previously treated unresectable or metastatic microsatellite instability-high or deficient mismatch repair colorectal cancer in China

Zhou

et al. 2023

Front. Oncol.

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ObjectiveThe aim of this study was to investigate the cost-effectiveness of serplulimab versus regorafenib in previously treated unresectable or metastatic microsatellite instability-high (MSI-H)/deficient mismatch repair (dMMR) colorectal cancer in China.MethodsFrom the perspective of China’s health-care system, a Markov model with three health states (progression free, progression, death) was developed for estimating the costs and health outcomes of serplulimab and regorafenib. Data for unanchored matching-adjusted indirect comparison (MAIC), standard parametric survival analysis, the mixed cure model, and transition probabilities calculation were obtained from clinical trials (ASTRUM-010 and CONCUR). Health-care resource utilization and costs were derived from government-published data and expert interviews. Utilities used to calculate quality-adjusted life years (QALYs) were obtained from clinical trials and literature reviews. The primary outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost/QALY gained. Four scenarios were considered in scenario analysis: (a) using original survival data without conducting MAIC; (b) limiting the time horizon to the follow-up time of the clinical trial of serplulimab; (c) adopting a fourfold increase in the risk of death; and (d) applying utilities from two other sources. One-way sensitivity analysis and probabilistic sensitivity analysis were also performed to assess the uncertainty of the results.ResultsIn the base-case analysis, serplulimab provided 6.00 QALYs at a cost of $68,722, whereas regorafenib provided 0.69 QALYs at a cost of $40,106. Compared with that for treatment with regorafenib, the ICER for treatment with serplulimab was $5,386/QALY, which was significantly lower than the triple GDP per capita of China in 2021 ($30,036), which was the threshold used to define the cost-effectiveness. In the scenario analysis, the ICERs were $6,369/QALY, $20,613/QALY, $6,037/QALY, $4,783/QALY, and $6,167/QALY, respectively. In the probabilistic sensitivity analysis, the probability of serplulimab being cost-effective was 100% at the threshold of $30,036/QALY.ConclusionCompared with regorafenib, serplulimab is a cost-effective treatment for patients with previously treated unresectable or metastatic MSI-H/dMMR colorectal cancer in China.

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Section: Main Findingssupporting

confidence: 89%

Section: Main Findingsmentioning

confidence: 99%

The cost-effectiveness analysis of serplulimab versus regorafenib for treating previously treated unresectable or metastatic microsatellite instability-high or deficient mismatch repair colorectal cancer in China

Zhou

et al. 2023

Front. Oncol.

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“…In the United States, the use of pembrolizumab as first-line treatment for MSI-H/dMMR advanced colorectal cancer strategy generated an incremental cost of $50,613.7 compared with that associated with chemotherapy, resulting in an incremental cost-benefit ratio (ICER) of $13,441 per quality life adjustment year (QALY) ( 16 ). In China, the pembrolizumab strategy yielded an incremental cost of $16,032.57, resulting in an ICER of $8,285 per QALY ( 17 ). Due to the high costs of nivolumab, nivolumab plus chemotherapy was not a cost-effective treatment strategy.…”

Section: Discussionmentioning

confidence: 99%

“… IHE items: ( 1 ) The hypothesis, purpose and objective of the study clearly stated; ( 2 ) describe the characteristics of the patient; ( 3 ) multi-center case collection; ( 4 ), the inclusion and exclusion criteria are clear and reasonable; ( 5 ), include patients consecutively; ( 6 ), patients are in the same condition; ( 7 ), describe the intervention clearly; ( 8 ), describe joint interventions clearly; ( 9 ), clarity the outcome of the measurement in advance; ( 10 ); reasonable objective and/or subjective methods to measure outcome; ( 11 ), outcome parameters were measured before and after the intervention; ( 12 ), reasonable statistical tests are used to evaluate the result parameters; ( 13 ), report follow-up time; ( 14 ), report loss follow-up; ( 15 ), data analysis of outcome measures provided random variable estimates; ( 16 ), report intervention-related adverse events; ( 17 ), research results support conclusions ( 18 ), statement of conflicts of interest and sources of support for the research; ( 19 ), prospective research; and (20), blind for outcome reviewers. IHE, The Canadian Institute of Health Economics.…”

Section: Figurementioning

confidence: 99%

Efficacy and safety of envafolimab in the treatment of advanced dMMR/MSI‑H solid tumors: A single‑arm meta‑analysis

Fan

Gai

et al. 2023

Oncol Lett

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In November 2021, the National Medical Products Administration (China) approved the marketing of envafolimab injection for the treatment of advanced defective mismatch repair (dMMR)/high microsatellite instability (MSI-H) solid tumors. Envafolimab became the first domestic PD-L1 inhibitor approved in China and the first worldwide approved subcutaneously injectable PD-L1 inhibitor. To the best of our knowledge, there are no reports of systematic analyses regarding the use of envafolimab in the treatment of advanced dMMR/MSI-H solid tumors. The present study was a single-arm meta-analysis performed on data systematically searched and retrieved from literature published on PubMed, Web of Science, Cochrane Library, China National Knowledge Infra-structure and Wan Fang databases on 1 October 2022. Quality assessment using the 20 items developed by the Canadian Institute of Health Economics. Data heterogenicity was evaluated using the I 2 statistics. For datasets with I 2 >50%, the cumulative incidence and 95% CI for the outcomes of interests were calculated using the random effects model, whereas for I 2 <50% the fixed effects model was used. The current meta-analysis included four studies enrolling 181 patients with advanced dMMR/MSI-H solid tumors. The pooled objective remission rate was 29.53% (95% CI, 8.61–50.45%). The pooled disease control rate was 60.58% (95% CI, 31.79–89.38%). The pooled median progression-free survival was 4.89 months (95% CI, 1.86–7.93 months). The pooled overall survival (OS) rate was 73.38% (95% CI, 65.76–80.99%). The pooled 6-month and 12-month OS rates were 75.80% (95% CI, 57.02–94.58%) and 69.32% (95% CI, 51.92–86.72%), respectively. The combined data on the incidence of treatment-emergent adverse events (TEAEs) of any grade from all the studies was 77.19% (95% CI, 63.15–91.23%). Most of the adverse reactions were mild and the rate of 3/4 grade TEAE was 10.37% (95% CI, 6.14–14.60%). Gevokizumab was effective and safe in the treatment of patients with advanced dMMR/MSI-H solid tumors and its convenience could significantly improve patient compliance; therefore, the clinical application of envafolimab is promising.

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“…At present, there are mainly immunotherapy methods such as immune checkpoint inhibitors, tumor vaccines, adoptive therapy and various compound preparations. Clinically commonly used immune checkpoint inhibitors, including programmed death receptor-1 (PD-1) inhibitors, programmed death ligand-1 (PD-L1) inhibitors, and cytotoxic T lymphocyt-associated protein 4(CTLA4) inhibitors, have enabled more advanced patients in various tumor species to achieve longer survival [11] .…”

Section: Immunotherapymentioning

confidence: 99%

Research Progress of Chinese and Western Medicine in the Treatment of CRC

2023

FMSR

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Colorectalcancer (CRC), with its high incidence and high mortality, has been a popular topic of research in China in recent years. At present, the treatment of CRC mainly includes surgery, radiotherapy and chemotherapy, molecular targeted therapy, and immunotherapy. Traditional Chinese medicine has unique advantages in reducing toxicity and increasing efficiency, improving patients' quality of life, and prolonging survival time. In this paper, the research progress of Chinese and western medicine treatment of CRC was reviewed in recent years, in order to provide positive reference for clinical treatment.

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Cost-effectiveness analysis of pembrolizumab versus chemotherapy for microsatellite instability-high or mismatch repair-deficient metastatic colorectal cancer

Cited by 5 publications

References 20 publications

The cost-effectiveness analysis of serplulimab versus regorafenib for treating previously treated unresectable or metastatic microsatellite instability-high or deficient mismatch repair colorectal cancer in China

The cost-effectiveness analysis of serplulimab versus regorafenib for treating previously treated unresectable or metastatic microsatellite instability-high or deficient mismatch repair colorectal cancer in China

Efficacy and safety of envafolimab in the treatment of advanced dMMR/MSI‑H solid tumors: A single‑arm meta‑analysis

Research Progress of Chinese and Western Medicine in the Treatment of CRC

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