Cost-effectiveness of chemotherapy in advanced and recurrent endometrial cancer

Objective

To review the cost-effectiveness of chemotherapy and immunotherapy-based regimens for advanced and recurrent endometrial cancer, focusing on incremental cost-effectiveness ratios (ICERs).

Methods

We conducted a literature review of peer-reviewed studies (2021–2025) evaluating immune checkpoint inhibitors (ICIs) combined with chemotherapy or targeted agents versus standard chemotherapy in advanced/recurrent endometrial cancer. Key outcomes (cost per QALY or life-year gained, willingness-to-pay [WTP] thresholds) and conclusions were extracted from nine studies.

Results

Adding ICIs to first-line chemotherapy improved survival, especially in mismatch repair-deficient (dMMR) tumors. In dMMR disease, pembrolizumab or dostarlimab plus chemotherapy yielded ICERs of $41,000–$60,000/QALY, considered cost-effective at a $150,000/QALY threshold, but not at $100,000/QALY without price reductions. In mismatch repair-proficient (pMMR) patients, first-line ICI combinations showed smaller QALY gains and higher ICERs ($90,000–$176,000/QALY), often exceeding accepted thresholds. The durvalumab + olaparib combination was not cost-effective in any subgroup (ICERs >$200,000/QALY). In recurrent pMMR disease, pembrolizumab + lenvatinib was not cost-effective in U.S. or Chinese settings unless drug costs declined by 8–50 %. In recurrent dMMR cancer, dostarlimab improved outcomes but had an ICER of $332,000/QALY, making it economically unjustified at current prices.

Conclusions

ICIs offer clinical benefit in advanced endometrial cancer, particularly in dMMR tumors. First-line ICI + chemotherapy appears cost-effective for dMMR at U.S. WTP levels. However, use in pMMR or second-line settings may require drug price reductions or biomarker-based selection to be economically viable.