First-line nivolumab plus chemotherapy <i>versus</i> chemotherapy alone for advanced gastric cancer, gastroesophageal junction cancer, and esophageal adenocarcinoma: a cost-effectiveness analysis

Cao, Xueqiong; Zhang, Mingming; Li, Na; Zheng, Bin; Liu, Maobai; Song, Xuan; Cai, Hongfu

doi:10.1177/17588359231171038

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…Individual patient data were inaccessible and had to be reconstructed according to Guyot’s algorithm, which might result in uncertainty. However, the method has been confirmed to have significantly less bias and better precision than others [ 31 , 32 ] and has been widely recommended for economic evaluation [ 33 , 34 ]. Second, optimal models were used to estimate the survival profile beyond the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of sacituzumab govitecan versus single-agent chemotherapy for metastatic triple-negative breast cancer: a trial-based analysis

Wu,

Hu,

Liu

et al. 2024

Cost Eff Resour Alloc

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Background Sacituzumab govitecan (SG) has recently been approved in China for the post-line treatment of metastatic triple-negative breast cancer (mTNBC). SG substantially improves progression-free survival and overall survival compared with single-agent chemotherapy for pretreated mTNBC. However, in view of the high price of SG, it is necessary to consider its value in terms of costs and outcomes. This study aimed to estimate the cost-effectiveness of SG versus single-agent treatment of physician’s choice (TPC) in the post-line setting for patients with mTNBC from a Chinese healthcare system perspective. Methods The cohort characteristics were sourced from the ASCENT randomized clinical trial, which enrolled 468 heavily pretreated patients with mTNBC between November 2017 and September 2019. A partitioned survival model was constructed to assess the long-term costs and effectiveness of SG versus TPC in the post-line treatment of mTNBC. Quality-adjusted life-months (QALMs) and total costs in 2022 US dollars were used to derive incremental cost effectiveness ratio (ICER). QALMs and costs were discounted at 5% annually. The willingness-to-pay (WTP) threshold was defined as $3188 per QALM, three times China’s average monthly per capita gross domestic product in 2022. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analyses were performed to estimate the robustness of the results. Results Treatment with SG yielded an incremental 5.17 QALMs at a cost of $44,792 per QALM, much above the WTP threshold of $3188/QALM in China. One-way sensitivity analysis showed that SG price was a crucial factor in the ICER. Probabilistic sensitivity analysis revealed that the cost-effective acceptability of SG was 0% in the current setting. Scenario analyses indicated that the result was robust in all subgroups in ASCENT or under different time horizons. Furthermore, SG must reduce the price to enter the Chinese mainland market. When the monthly cost of SG reduce to $2298, SG has about 50% probability to be a preferred choice than TPC. Conclusions SG was estimated to be not cost-effective compared with TPC for post-line treatment for mTNBC in China by the current price in HK under a WTP threshold of $3188 per QALM. A drastic price reduction is necessary to improve its cost-effectiveness.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of sacituzumab govitecan versus single-agent chemotherapy for metastatic triple-negative breast cancer: a trial-based analysis

Wu,

Hu,

Liu

et al. 2024

Cost Eff Resour Alloc

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“…The quality of life is assumed to be related to the progressive stage of the tumor. Therefore, the utility value for PF state was estimated to be 0.797 and 0.577 for tpatients 29–32 . The utility decrement for chemotherapy‐related adverse events was estimated as 0.044 based on a systematic review 33 .…”

Section: Methodsmentioning

confidence: 99%

Pembrolizumab alone or in combination with chemotherapy versus chemotherapy for advanced gastric cancer: A cost‐effectiveness analysis

Lang,

Lin,

et al. 2023

Cancer Medicine

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PurposeThe KEYNOTE‐062 trial demonstrated the efficacy and safety of pembrolizumab for advanced gastric cancer (GC). The current study evaluated the cost‐effectiveness of pembrolizumab alone or in combination with chemotherapy versus chemotherapy for advanced GC from the perspective of the United States and China. And the results will provide evidence and data support for more drug selection‐related decisions and research in the future.MethodsA partitioned survival approach with three states was created for treatment of advanced GC. The survival data were derived from KEYNOTE‐062 trial and the individual patient data were generated by a specific algorithm. We fitted 21 survival functions to each treatment arm and selected the most suitable distribution type for each one. Direct costs and utility values were collected from the published, available database. Cost, quality‐adjusted life‐years (QALYs), and incremental cost‐utility ratios (ICURs) were considered as the primary measure outcomes. One‐way and probabilistic sensitivity analyses were performed to assess the reliability of the analyses.ResultsIn the base‐case analysis of combined positive score (CPS) ≥1 patients, the ICUR of pembrolizumab plus chemotherapy versus chemotherapy in American and Chinese setting is $345,209/QALY and $186,802.6/QALY, respectively. And the ICUR of pembrolizumab versus chemotherapy is $473,650/QALY and $377,753/QALY in the context of the US and China, respectively. For CPS≥10 patients, the ICUR of pembrolizumab plus chemotherapy versus chemotherapy in American and Chinese setting is $483,742/QALY and $262,965/QALY, respectively. And that of pembrolizumab versus chemotherapy is $96,550/QALY and $67,896/QALY in the context of the US and China.ConclusionCompared with chemotherapy, either pembrolizumab plus chemotherapy or pembrolizumab monotherapy is not regarded as a cost‐effective strategy for patients with CPS≥1, advanced gastric cancer in the current American and Chinese setting. But pembrolizumab monotherapy for CPS≥10 patients would become a cost‐effective option in the American setting.

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“…Currently, the market for gastric cancer immunotherapy is limited to HER2-targeted drugs [ 10 – 12 ], anti-PD-(L)1 agents [ 13 , 14 ] and anti-VEGFR treatments [ 15 ]. However, these therapies have shown only modest benefits in gastric/GEJ cancer patients, with objective response rates (ORR) ranging between 3 and 11% [ 14 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

DR30318, a novel tri-specific T cell engager for Claudin 18.2 positive cancers immunotherapy

Ma,

Zhou,

Duan

et al. 2024

Cancer Immunol Immunother

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Background Claudin 18.2 (CLDN18.2) is a highly anticipated target for solid tumor therapy, especially in advanced gastric carcinoma and pancreatic carcinoma. The T cell engager targeting CLDN18.2 represents a compelling strategy for enhancing anti-cancer efficacy. Methods Based on the in-house screened anti-CLDN18.2 VHH, we have developed a novel tri-specific T cell engager targeting CLDN18.2 for gastric and pancreatic cancer immunotherapy. This tri-specific antibody was designed with binding to CLDN18.2, human serum albumin (HSA) and CD3 on T cells. Results The DR30318 demonstrated binding affinity to CLDN18.2, HSA and CD3, and exhibited T cell-dependent cellular cytotoxicity (TDCC) activity in vitro. Pharmacokinetic analysis revealed a half-life of 22.2–28.6 h in rodents and 41.8 h in cynomolgus monkeys, respectively. The administration of DR30318 resulted in a slight increase in the levels of IL-6 and C-reactive protein (CRP) in cynomolgus monkeys. Furthermore, after incubation with human PBMCs and CLDN18.2 expressing cells, DR30318 induced TDCC activity and the production of interleukin-6 (IL-6) and interferon-gamma (IFN-γ). Notably, DR30318 demonstrated significant tumor suppression effects on gastric cancer xenograft models NUGC4/hCLDN18.2 and pancreatic cancer xenograft model BxPC3/hCLDN18.2 without affecting the body weight of mice.

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First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric cancer, gastroesophageal junction cancer, and esophageal adenocarcinoma: a cost-effectiveness analysis

Cited by 4 publications

References 28 publications

Cost-effectiveness of sacituzumab govitecan versus single-agent chemotherapy for metastatic triple-negative breast cancer: a trial-based analysis

Cost-effectiveness of sacituzumab govitecan versus single-agent chemotherapy for metastatic triple-negative breast cancer: a trial-based analysis

Pembrolizumab alone or in combination with chemotherapy versus chemotherapy for advanced gastric cancer: A cost‐effectiveness analysis

DR30318, a novel tri-specific T cell engager for Claudin 18.2 positive cancers immunotherapy

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