Cost-effectiveness analysis of sintilimab plus chemotherapy for advanced or metastatic esophageal squamous cell carcinoma

Abstract

BackgroundSintilimab plus chemotherapy (SIDCHM) is more effective than placebo plus chemotherapy (PLCHM) for advanced or metastatic esophageal squamous cell carcinoma (ESCC). However, considering the high cost of sintilimab, this study evaluated the cost-effectiveness of SIDCHM in comparison with PLCHM for advanced or metastatic ESCC from the Chinese healthcare system perspective.MethodsPolymorphic Markov models were constructed to simulate the course and cost of SIDCHM. Treatment drug costs were calculated at national list prices and clinical data, other costs, and utility values were extracted from the reference literature. Primary outcomes included quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). The robustness of the model was verified by one-way sensitivity analysis and probabilistic sensitivity analysis (PSA).ResultsSIDCHM obtained 1.03 QALYs at $24,044.49, whereas the effectiveness and cost of PLCHM were 0.67 QALYs and $14,166.24, respectively. The ICER for SIDCHM versus PLCHM was $23,458.08/QALY. The utility of the PFS state was the parameter that had the greatest effect on the ICER. The PSA showed that SIDCHM had an 86% probability of being cost-effective at the willingness-to-pay threshold of 3* Chinese gross domestic product per capita ($37,653/QALY).ConclusionFrom the Chinese healthcare system perspective, SIDCHM is considered a cost-effective treatment option compared with PLCHM as first-line therapy for advanced or metastatic ESCC.

Economic evaluation of serplulimab plus chemotherapy as the first-line treatment of oesophageal squamous cell carcinoma in China

“…Zhang et al assessed the economics of adding camrelizumab to the first-line chemotherapy from the viewpoint of the Chinese healthcare system and showed that camrelizumab plus chemotherapy was still unlikely to have a cost-effectiveness advantage 20. Four studies evaluated the cost-effectiveness of sintilimab in combination with chemotherapy in the treatment of OSCC in China, and the results of these studies all showed that sintilimab+chemotherapy may be an economical option 30–33. Pembrolizumab is an imported drug, and the price has never decreased since it was launched in China (US$2589.49 per 200 mg).…”

“…First, the large cost gap and weak survival benefit gap between immunotherapy and chemotherapy lead to higher ICER. In terms of the first-line PD-(L)1 inhibitors in OSCC, most of the published economic studies showed that the incremental QALYs generated by immunotherapy combined with chemotherapy were less than 1 QALY, and only 1 study achieved 1.23 QALYs, while the incremental cost was at least US$7110 and at most US$53 320, resulting in a high ICER 15 20 29–33…”

“…20 Four studies evaluated the cost-effectiveness of sintilimab in combination with chemotherapy in the treatment of OSCC in China, and the results of these studies all showed that sintilimab+chemotherapy may be an economical option. [30][31][32][33] Pembrolizumab is an imported drug, and the price has never decreased since it was launched in China (US$2589.49 per 200 mg). Camrelizumab is a domestic PD-1 inhibitor developed by China.…”

The cost-effectiveness of cemiplimab plus chemotherapy as the first-line treatment for advanced non-small cell lung cancer

“…Because the EMPOWER-LUNG 3 trial lacked subsequent regimens after patients entered the PD state, we referred to some studies ( Wu et al, 2020 ; Chen et al, 2022a ; You et al, 2022b ), assuming that patients in both the CCT and PCT groups received the best supportive care (BSC) after their disease progressed until death.…”