Cost-effectiveness of chemotherapy for advanced and recurrent cervical cancer: a systematic review.

Abstract

Introduction: Advanced and recurrent cervical cancer often requires palliative chemotherapy and is associated with poor prognosis. Recently, various systemic therapies-including cytotoxic drugs, anti-angiogenic agents, and immune checkpoint inhibitors-have been evaluated for their cost-effectiveness.

Methods: We conducted a systematic review of English language-based research publications reporting incremental cost-effectiveness ratios (ICERs) for chemotherapy-based treatments in advanced or recurrent cervical cancer. Literature was retrieved from PubMed, Scopus, and Web of Science without date restrictions and screened based on predefined eligibility criteria. A total of 10 studies were included.

Results: Traditional first-line platinum-based doublet chemotherapy (e.g., cisplatin plus paclitaxel) was consistently found to be cost-effective, with ICERs well below common willingness-to-pay (WTP) thresholds. The addition of bevacizumab improved survival but increased costs, yielding borderline or unfavorable ICERs (e.g., $155,000/QALY in the U.S.). Immunotherapy agents such as pembrolizumab and cadonilimab offered clinical benefits but often exceeded WTP thresholds, particularly in low- and middle-income settings. Cemiplimab had an ICER of $111,000/QALY as a second-line treatment, near the upper U.S. WTP threshold, while agents like tisotumab vedotin were not economically viable at current prices. Cost-effectiveness varied across regions depending on pricing, healthcare systems, and local WTP thresholds.

Discussion: Although newer agents provide incremental survival benefits, their high costs often outweigh QALY gains. Policymakers and clinicians should consider the economic impact of adopting such therapies and prioritize value-based strategies, including price negotiations, biosimilar use, and biomarker-guided patient selection. Future research should promote evidence-based pricing and access models to support sustainable cancer care worldwide.