Xinqiang Zhao, Longjiang She, Xiaoning Liu, Zhenggang Bi
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引用次数: 0
Abstract
Objectives: Recently, NRG-GY018 clinical trial demonstrated that adding pembrolizumab to chemotherapy led to significantly longer progression-free survival than chemotherapy alone in the first-line treatment of advanced or recurrent endometrial cancer (a/rEC). This analysis aimed to estimate the cost-effectiveness of pembrolizumab plus paclitaxel plus carboplatin chemotherapy (PC) as the first-line treatment for a/rEC in the US and China.
Methods: A Markov model based on the clinical data from NRG-GY018 trial was established to estimate the cost and efficacy of PC and paclitaxel plus carboplatin groups for a/rEC in mismatch repair-proficient (pMMR) and mismatch repair-deficient (dMMR) populations. Direct medical costs and utility values were collected from the government databases, local databases, and published literatures. The main outcomes were incremental cost-effectiveness ratios (ICERs), incremental monetary benefit (INMB), and incremental net-health benefit (INHB). The robustness of the model was assessed using one-way and probabilistic sensitivity analyses.
Results: With the 5-year time horizon, treatment with PC gained an additional 0.87 QALYs (1.34 LYs) in pMMR and 4.17 QALYs (5.14 LYs) in the dMMR population. In the US, the ICERs of PC compared to chemotherapy were 404,575 $/QALY in pMMR and 124,406 $/QALY in dMMR patients, respectively. In China, the ICERs of PC compared to chemotherapy were 220,259 $/QALY and 70,207 $/QALY in pMMR and dMMR populations, respectively. The results of sensitivity analyses supported the robustness of our models.
Conclusions: For patients with a/rEC, PC was cost-effective compared with chemotherapy in the first-line treatment for dMMR populations in the US. However, the combination of pembrolizumab with chemotherapy was not a cost-effective strategy for pMMR a/rEC in the US and a/rEC in China regardless of the MMR status, a price reduction process is required to reach the traditional cost-effectiveness threshold.
期刊介绍：
Cost Effectiveness and Resource Allocation is an Open Access, peer-reviewed, online journal that considers manuscripts on all aspects of cost-effectiveness analysis, including conceptual or methodological work, economic evaluations, and policy analysis related to resource allocation at a national or international level. Cost Effectiveness and Resource Allocation is aimed at health economists, health services researchers, and policy-makers with an interest in enhancing the flow and transfer of knowledge relating to efficiency in the health sector. Manuscripts are encouraged from researchers based in low- and middle-income countries, with a view to increasing the international economic evidence base for health.
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