Cost-Effectiveness Analysis of Toripalimab Plus Paclitaxel and Cisplatin as First-Line Treatment for Advanced or Metastatic Esophageal Squamous Cell Carcinoma

Adv Ther. 2023 Mar;40(3):1019-1030. doi: 10.1007/s12325-022-02402-z. Epub 2023 Jan 9.


Introduction: First-line treatment with toripalimab plus paclitaxel and cisplatin (TTP) is very effective for patients with advanced or metastatic esophageal squamous cell carcinoma (ESCC) in China, although its effects on economic burden are unknown. The present study aimed to evaluate the cost-effectiveness of TTP from the perspective of the Chinese healthcare system.

Methods: A Markov model was established to evaluate the cost-effectiveness of first-line treatment with TTP for patients with advanced or metastatic ESCC. Survival data were derived from the JUPITER-06 trial. The costs and utilities were gathered from the literature and a local database. The primary outcomes were total costs, quality-adjusted life year (QALY), and incremental cost-effectiveness ratios (ICERs) at a willingness-to-pay (WTP). One-way and probability sensitivity analyses were used to evaluate the robustness of the model.

Results: The total cost of TTP was $123,646.43 and gained 1.10 QALYs, while the paclitaxel and cisplatin (TP) chemotherapy group yielded 0.84 QALY at cost of $16,259.65. First-line TTP treatment yielded an incremental cost of $7,386.78 with an additional 0.26 QALY, providing an ICER of $28,348.42/QALY, which was lower than the WTP threshold ($36,257.91) in China.

Conclusions: TTP was likely more cost-effective than TP chemotherapy from the perspective of the Chinese healthcare system. This study may provide evidence required to establish decision-making criteria to support guidance for cost-effective selection of an immunotherapeutic regimen.

Keywords: Cisplatin; Cost-effectiveness analysis; Esophageal squamous cell carcinoma; Paclitaxel; Toripalimab.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Cisplatin / therapeutic use
  • Cost-Benefit Analysis
  • Cost-Effectiveness Analysis
  • Esophageal Neoplasms* / drug therapy
  • Esophageal Squamous Cell Carcinoma* / drug therapy
  • Humans
  • Markov Chains
  • Paclitaxel / therapeutic use
  • Quality-Adjusted Life Years


  • Paclitaxel
  • Cisplatin
  • toripalimab