Pembrolizumab Plus Chemotherapy as First-Line Treatment for Advanced Esophageal Cancer: A Cost-Effectiveness Analysis

Ying, Zhu; Liu, Kun; Ding, Dong; Zhou, Yangying; Peng, Libo

doi:10.1007/s12325-022-02101-9

Cited by 31 publications

(51 citation statements)

References 45 publications

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“…Two studies suggest that pembrolizumab was not cost-effective in advanced esophageal cancer, with Zhan et al (2022) suggesting an increased cost of $37,201.68 for pembrolizumab compared to chemotherapy alone while obtaining a QALY of 0.23. Zhu et al (2022) suggested an ICER per QALY for pembrolizumab plus chemotherapy compared to chemotherapy of $550,211 in the United States and China were $244,580/QALY and $258,261/QALY, respectively. Pembrolizumab plus chemotherapy yielded 0.386–0.607 QALYs (0.781–1.195 LYs) compared with chemotherapy alone, and both studies had well above the standard WTP.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the encouraging clinical performance, the high treatment cost of sintilimab has been under the spotlight. Current cost-effective analyses of sintilimab are mostly conducted for hepatocellular carcinoma and non-small-cell lung carcinoma ( Peng et al, 2022 ; Zhou et al, 2022 ; Zhu et al, 2022 ). Studies on the cost-effectiveness of sintilimab combined with chemotherapy as the first-line treatment for esophageal carcinoma need to be conducted.…”

Section: Introductionmentioning

confidence: 99%

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Cost-Effectiveness Analysis of Sintilimab Combined with Chemotherapy Versus Chemotherapy Alone as the First-Line Treatment for Advanced Esophageal Cancer

Zeng

et al. 2022

Front. Pharmacol.

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Background: Esophageal cancer has a poor prognosis and currently ranks sixth in global cancer mortality rates. The ORIENT-15 trial showed sintilimab plus chemotherapy significantly improved survival when compared to chemotherapy alone. This study aimed to evaluate the cost-effectiveness of sintilimab, a programmed death-ligand 1 (PD-L1) inhibitor, plus chemotherapy in treating patients with esophageal cancer compared with chemotherapy alone.Methods: A Markov model with a 10-year horizon was developed based on the perspective of the Chinese healthcare payers. We conducted a cost-effectiveness analysis for sintilimab combined with chemotherapy based on a questionnaire. Patients were grouped into the sintilimab group based on a positive score of 10 or more (combined positive score (CPS) ≥ 10 groups), and those with any other PD-L1 expression were randomized into patient groups. We estimated the cost and the effectiveness of sintilimab on the quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) was computed. One-way and probabilistic sensitivity analyses were conducted to explore the impact of uncertainties on the cost-effectiveness results.Results: In the base-case analysis, compared with chemotherapy alone, the ICER of sintilimab plus chemotherapy for all patients was $21024.05 per QALY, and in the CPS≥10 group, it was $20974.23 per QALY. This was lower than $37653 per QALY. One-way sensitivity analysis demonstrated that ICERs were most sensitive to the price of sintilimab.Conclusion: The study demonstrated that sintilimab plus chemotherapy for advanced esophageal cancer as its first-line treatment would be more cost-effective than chemotherapy alone in Chinese patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Sintilimab Combined with Chemotherapy Versus Chemotherapy Alone as the First-Line Treatment for Advanced Esophageal Cancer

Zeng

et al. 2022

Front. Pharmacol.

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“…BSA, body surface area; PD, progressive disease; PFS, progression-free survival; PLCHM, placebo plus chemotherapy; SIDCHM, sintilimab plus chemotherapy7. (11,25). From a Chinese healthcare system perspective, Zhang et al concluded that the probability of camrelizumab in addition to chemotherapy being cost-effective as a first-line treatment option for advanced or metastatic ESCC was lower than about 1% when compared with conventional chemotherapy at a costeffectiveness threshold of $31,498.70, and the factor that had the greatest impact on the ICER was the cost of 200 mg of camrelizumab (11).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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“…After disease progression, all patients had the same opportunity to receive second-line treatment according to the guidelines of the Chinese Society of Clinical Oncology (CSCO) for oesophageal cancer (2021) [20] and the ORIENT-15 data [10]. All costs were obtained from local hospitals and previously published literature [21][22][23][24][25][26][27][28]. All costs were adjusted to US dollars in 2021 ($1 = 6.45…”

Section: Cost and Utility Estimatesmentioning

confidence: 99%

“…The utility values for health states in the model were derived from a worldwide, randomized, double-blind phase III clinical study that recruited patients with advanced gastric cancer or gastroesophageal junction adenocarcinoma [22,29]. The disutility caused by adverse events was also considered in this cost-effectiveness analysis [21,27]. The key model parameters are shown in Table 2.…”

Section: Cost and Utility Estimatesmentioning

confidence: 99%

Cost-effectiveness analysis of sintilimab plus chemotherapy versus chemotherapy alone for the first-line treatment of advanced oesophageal squamous cell carcinoma

Nie

Gao

et al. 2022

Preprint

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Background Recent clinical trials have illustrated the superior efficacy and safety of sintilimab plus chemotherapy compared to chemotherapy alone in patients with advanced oesophageal squamous cell carcinoma. Aim This study aimed to evaluate the cost-effectiveness of sintilimab combined with chemotherapy vs. Chemotherapy alone as first-line treatment for advanced oesophageal squamous cell carcinoma patients in China. Method A partitioned survival model was developed to compare the lifetime costs and quality-adjusted life years of different treatment regimens. Sensitivity analysis was conducted to verify the robustness of the model results. Results Compared with chemotherapy alone, the sintilimab combination strategy resulted in an additional 0.58 quality-adjusted life years. The incremental cost-effectiveness ratio was $14,967.31/quality-adjusted life years, lowering the willingness-to-pay threshold ($37,663.26). Subgroup analysis demonstrated that sintilimab + chemotherapy was more cost-effective for patients with PD-L1 CPS ≥ 10. Sensitivity analysis confirmed the base-case analysis results. Conclusion The sintilimab combination strategy is a cost-effective option for first-line treatment of advanced oesophageal squamous cell carcinoma patients in China.

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Pembrolizumab Plus Chemotherapy as First-Line Treatment for Advanced Esophageal Cancer: A Cost-Effectiveness Analysis

Cited by 31 publications

References 45 publications

Cost-Effectiveness Analysis of Sintilimab Combined with Chemotherapy Versus Chemotherapy Alone as the First-Line Treatment for Advanced Esophageal Cancer

Cost-Effectiveness Analysis of Sintilimab Combined with Chemotherapy Versus Chemotherapy Alone as the First-Line Treatment for Advanced Esophageal Cancer

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

Cost-effectiveness analysis of sintilimab plus chemotherapy versus chemotherapy alone for the first-line treatment of advanced oesophageal squamous cell carcinoma

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