Economic evaluation of tislelizumab versus chemotherapy as second-line treatment for advanced or metastatic esophageal squamous cell carcinoma in China

Shi, Fenghao; He, Zixuan; Wang, Lin; Han, Sheng

doi:10.3389/fphar.2022.961347

Cited by 9 publications

(11 citation statements)

References 23 publications

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“… 24 , 54 , 55 These studies found that camrelizumab was cost-effective in China. Shi et al 23 performed an economic evaluation of tislelizumab in second-line treatment for advanced OSCC from the Chinese healthcare payers’ perspective and estimated an ICER of $11,073.85 per QALY gained. These findings were consistent with our study, although the input parameters in these studies were slightly different from ours.…”

Section: Discussionmentioning

confidence: 99%

“… 21 , 22 There is a scarcity of comprehensive economic assessments related to second-line treatment options, which are currently confined solely to comparisons between immunotherapy and chemotherapy. 23 – 25 Consequently, conducting pertinent cost-effectiveness analyses is imperative to properly address the dilemmas of policy formulation and clinical practice. 26 …”

Section: Introductionmentioning

confidence: 99%

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Immune checkpoint inhibitors versus chemotherapy as second-line therapy for advanced oesophageal squamous cell carcinoma: a systematic review and economic evaluation

Liu,

Dou,

2024

Therap Adv Gastroenterol

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Background: Recently, several novel programmed cell death protein 1 (PD-1) inhibitors have been approved for second-line treating advanced or metastatic oesophageal squamous cell carcinoma (OSCC), including camrelizumab, nivolumab, pembrolizumab, sintilimab and tislelizumab. However, the optimal treatment regimen remained ambiguous. Objectives: The purpose of this study was to investigate the efficacy, safety and economy of available PD-1 inhibitors to determine the optimal treatment from the Chinese healthcare system perspective. Design: A systematic review and economic evaluation. Data sources and methods: A systematic review was undertaken utilizing PubMed, Web of Science, Cochrane Library, Embase and Scopus databases to identify eligible studies until 31 August 2023. Primary outcomes were progression-free survival (PFS), overall survival (OS) and adverse events (AEs). We also developed a partitioned survival model at 3-week intervals based on five clinical trials to predict long-term costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios for various treatment options. Direct medical costs and utility values were obtained from public drug bidding databases, clinical trials or published literature. The parameter uncertainties within the model were determined via one-way and probabilistic sensitivity analyses. Results: Five randomized controlled trials involving 2837 patients were included in the analysis. Compared with other treatments examined, camrelizumab provided the best PFS benefits [hazard ratio (HR): 0.69, 95% confidence interval (CI): 0.56–0.86], and pembrolizumab provided the best OS benefits (HR: 0.55, 95% CI: 0.37–0.82). Nivolumab caused a relatively lower incidence of treatment-related AEs (HR: 0.10, 95% CI: 0.05–0.20) and grade 3–5 AEs (HR: 0.13, 95% CI: 0.08–0.21) than other immunotherapy regimens. In the economic evaluation, average 10-year costs ranged from $5,433.86 (chemotherapy) to $50,617.95 (nivolumab) and mean QALYs ranged from 0.55 (chemotherapy) to 0.82 (camrelizumab). Pembrolizumab was eliminated because of dominance. Of the remaining strategies, when the willingness-to-pay thresholds were 1, 2 and 3 times GDP per capita in 2022, sintilimab, tislelizumab and camrelizumab were the most cost-effective treatment options, respectively. Conclusion: Sintilimab might be the optimal treatment alternative for second-line therapy of advanced OSCC in China, followed by tislelizumab and camrelizumab. Trial registration: This study has been registered on the PROSPERO database with the registration number CRD42023495204.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Immune checkpoint inhibitors versus chemotherapy as second-line therapy for advanced oesophageal squamous cell carcinoma: a systematic review and economic evaluation

Liu,

Dou,

2024

Therap Adv Gastroenterol

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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ObjectiveThe ASTRUM-007 trial (NCT03958890) demonstrated that serplulimab plus chemotherapy administered every 2-week significantly improved progression-free and overall survival in patients with previously untreated, programmed death-ligand 1 (PD-L1) positive advanced esophageal squamous-cell carcinoma (ESCC). This study was aimed to investigate the cost-effectiveness of serplulimab plus chemotherapy in the first-line treatment of PD-L1-positive advanced ESCC.MethodsA partitioned survival model with a 2-week cycle and a 10-year time horizon was constructed from the Chinese healthcare system perspective. The survival data, direct medical costs and utilities were derived from the ASTRUM-007 trial, YAOZHI database and published sources. Total costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. Scenario, one-way and probabilistic sensitivity analyses were performed to assess the uncertainty around model parameters.ResultsCompared with chemotherapy, serplulimab plus chemotherapy provided additional 0.27 QALYs with an incremental cost of $33,460.86, which had an ICER of $124,483.07 per QALY. The subgroup analyses revealed that the ICERs of serplulimab plus chemotherapy were $134,637.42 and $105,589.71 in advanced ESCC patients with 1 ≤ CPS < 10 and CPS ≥ 10, respectively. The price of serplulimab, patient weight, utility values and discount rate were the most influential parameters on base-case results. At a willingness-to-pay threshold of three times per capita GDP ($40,587.59) in 2022, the probability of serplulimab plus chemotherapy being cost-effective was 0% compared with chemotherapy. When the price of serplulimab decreased by 70%, the probabilities of serplulimab plus chemotherapy being cost-effective were 81.42%, 67.74% and 96.75% in advanced ESCC patients with PD-L1-positive, PD-L1 1≤CPS<10 and CPS≥10, respectively.ConclusionSerplulimab plus chemotherapy in the first-line treatment for PD-L1-positive advanced ESCC might not be cost-effective in China.

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“…Due to the lack of ESCC-related utility studies, the utility value parameters for this study were derived from a clinical study of adenocarcinoma of the stomach or gastroesophageal junction, which may have in uenced the results. However, the utility values from this study have been cited in several published ESCC-related economic evaluations [9,19,22,28,32,33] . Second, since the PFS curves of tislelizumab before and after MAIC adjustment relative to the chemotherapy group and the PFS curves of camrelizumab relative to the chemotherapy group did not meet the PH assumption, the HR values of both relative to the chemotherapy group were not used for the calculation of this study, but were extrapolated by tting the parameters to their respective IPDs, which may have biased the results to some extent.…”

Section: Discussionmentioning

confidence: 99%

“…This showed that the choice of model type and the perspective of the studies did not affect the results of the cost-effectiveness of camrelizumab versus the chemotherapy group. Shi et al used a PSM to compare the costeffectiveness of tislelizumab versus chemotherapy as a second-line treatment for advanced or metastatic ESCC in China and found that tislelizumab therapy was highly cost-effective compared with chemotherapy therapy [31] . It implied that tislelizumab could be a promising strategy for treating ESCC patients in the setting of China.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of Tislelizumab vs. Camrelizumab for the treatment of second-line locally advanced or metastatic esophageal squamous cell carcinoma

Chen

Shen

et al. 2023

Preprint

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Background Tislelizumab is a selective PD-1 inhibitor with efficacy proven in locally advanced or metastatic esophageal squamous cell carcinoma. The study aims to evaluate the cost-effectiveness of tislelizumab versus camrelizumab as the second-line treatment in locally advanced or metastatic esophageal squamous cell carcinoma (ESCC) patients in China.Methods From the perspective of China’s healthcare system, the partitioned survival model with three health states was established in a 3-week cycle and a lifetime horizon. Anchored matching adjusted indirect comparison was used for survival analyses based on individual patient data from RATIONALE 302 trial and the published ESCORT study due to the lack of head-to-head clinical trials. Only direct medical costs were included. Costs and utility values were derived from local charges, the published literature, and related databases. Sensitivity analyses and a scenario analysis were also performed to verify the robustness of the model results.Results Compared with camrelizumab monotherapy, tislelizumab monotherapy incurred a lower lifetime cost ($8,346 vs. 8,851) and yielded higher quality-adjusted life-years (QALYs) (0.87 vs. 0.63), which resulted in an incremental cost-effectiveness ratio (ICER) of -$2,051/QALY. Tislelizumab monotherapy is a dominant option over camrelizumab monotherapy in China. The three primary parameters upon which this result was most sensitive were the unit cost of camrelizumab, the unit cost of tislelizumab, and the duration of reactive cutaneous capillary endothelial proliferation (RCCEP). According to the probabilistic sensitivity analysis (PSA), tislelizumab monotherapy was 100% cost-effective when the WTP was 1–3 times GDP per capita in China($11,207/QALY∼$33,621/QALY). Scenario analysis showed that the result was consistent.Conclusion Tislelizumab monotherapy is a dominant option compared with camrelizumab monotherapy as the second-line treatment for locally advanced or metastatic ESCC in China.

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Economic evaluation of tislelizumab versus chemotherapy as second-line treatment for advanced or metastatic esophageal squamous cell carcinoma in China

Cited by 9 publications

References 23 publications

Immune checkpoint inhibitors versus chemotherapy as second-line therapy for advanced oesophageal squamous cell carcinoma: a systematic review and economic evaluation

Immune checkpoint inhibitors versus chemotherapy as second-line therapy for advanced oesophageal squamous cell carcinoma: a systematic review and economic evaluation

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

Cost-effectiveness analysis of Tislelizumab vs. Camrelizumab for the treatment of second-line locally advanced or metastatic esophageal squamous cell carcinoma

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