Cost-effectiveness of sintilimab plus chemotherapy versus chemotherapy alone as first-line treatment of locally advanced or metastatic oesophageal squamous cell carcinoma

Abstract

BackgroundSintilimab plus chemotherapy significantly prolongs overall survival (OS) for patients with advanced or metastatic oesophageal squamous cell carcinoma (OSCC). However, the cost-effectiveness of this high-priced therapy is currently unknown. We evaluated the cost-effectiveness of sintilimab plus chemotherapy vs chemotherapy alone as fist-line therapy in patients with advanced or metastatic OSCC from the perspective of Chinese healthcare system.MethodsA partitioned survival model consisting of 3 discrete health states was constructed to assess the cost and effectiveness of sintilimab plus chemotherapy vs chemotherapy as first-line treatment of OSCC. Key clinical data in the model came from the ORIENT-15 trial. Costs and utilities were collected from published sources. Life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefits (INHB), and incremental net monetary benefits (INMB) were calculated for the two treatment strategies. One-way and probabilistic sensitivity analyses were conducted to account for uncertainty and model stability. Additional subgroup and scenario analyses were performed.ResultsTreatment with sintilimab plus chemotherapy provided an additional 0.37 QALYs and an incremental cost of $8,046.58 compared with chemotherapy, which resulted in an ICER of $21,782.24 per QALY gained. One-way sensitivity analysis revealed that the model was most sensitive to utility of progression-free survival (PFS) and the cost of sintilimab. The probabilistic sensitivity analysis indicated that the probability of sintilimab plus chemotherapy being cost-effective was 0.01%, 76.80% and 98.60% at the threshold of 1, 2 or 3 times GDP per capita per QALY, respectively. Subgroup analysis found that all subgroups other than PD-L1 expression combined positive scores < 1 subgroup favored sintilimab plus chemotherapy treatment due to its association with positive INHBs by varying the hazard ratios for OS and PFS. The scenario analyses showed altering the time horizon of the model or fitting survival curves separately did not reverse results of the model.ConclusionSintilimab plus chemotherapy was associated with improved QALYs and an additional cost but was estimated to be cost-effective compared with chemotherapy alone as a first-line treatment for patients with advanced or metastatic OSCC at the commonly adopted willingness-to-pay threshold of 3 times GDP per capita per QALY in China.

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

“…Currently, numerous studies are targeted on the economic evaluations of immunotherapies for advanced ESCC patients and warrant discussion. At the current price and WTP threshold, domestic PD-1 inhibitors, such as camrelizumab, sintilimab, tislelizumab and toripalimab, were cost-effective options as first- or second-line treatment for patients with advanced ESCC in China ( 18 , 29 , 38 – 40 ). The dynamic adjustment mechanism of the national medical insurance catalog has played a predominant role in this situation.…”

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…”

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

“…The health state utility values utilized in our model were obtained from previously published literature since quality of life for patients in the RATIONALE-306 trial was unavailable. Specifically, the utility value for progression-free survival (PFS) and disease progression (PD) in patients with advanced or metastatic OSCC were determined to be 0.75 and 0.60, respectively [ 23 ].…”

“…One-way deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA) were performed to assess the robustness of the model. In DSA, drug prices were adjusted within the range of the purchase price, the cost of tislelizumab was subject to a ± 20% adjustment range because there was only one purchase price, the discount rate varied from 0 to 8% [ 30 ], and ranges for other parameters were assumed to be reasonable ranges (±20%) referring to previous publications since 95% confidence intervals (CI) was not available [ 8 , 23 ]. The impact of each input parameter on the model results was shown in the tornado diagram.…”