Cost-effectiveness analysis of PD-1 inhibitors as second-line therapy for advanced or metastatic esophageal squamous cell carcinoma in China: an economic evaluation based on network meta-analysis

Shuang Liu; Linbo Zhao; Fenghao Shi; Liping Kuai; Ruizhe Liu; Jianhua Tang

doi:10.1007/s11096-023-01696-5

Cost-effectiveness analysis of PD-1 inhibitors as second-line therapy for advanced or metastatic esophageal squamous cell carcinoma in China: an economic evaluation based on network meta-analysis

Int J Clin Pharm. 2024 Feb 26. doi: 10.1007/s11096-023-01696-5. Online ahead of print.

Authors

Shuang Liu^#¹, Linbo Zhao^#¹, Fenghao Shi², Liping Kuai³, Ruizhe Liu⁴, Jianhua Tang⁵

Affiliations

¹ Hebei Key Laboratory of Neuropharmacology, Department of Pharmacy, Hebei North University, 11, South Diamond Road, Qiaodong District, Zhangjiakou, People's Republic of China.
² International Research Center for Medicinal Administration, Peking University, 38, Xueyuan Road, Haidian District, Beijing, People's Republic of China.
³ Science and Technology Development Center of Chinese Pharmaceutical Association, 38, Yongda Road, Daxing District, Beijing, People's Republic of China.
⁴ Department of Pharmacy, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Haizhu District, Guangzhou, People's Republic of China.
⁵ Institute of Disaster and Emergency Medicine, Tianjin University, 92, Weijin Road, Nankai District, Tianjin, People's Republic of China. jhtang2002@tju.edu.cn.

^# Contributed equally.

PMID: 38407692
DOI: 10.1007/s11096-023-01696-5

Abstract

Background: Several economic studies have assessed the cost-effectiveness of programmed cell death protein-1 (PD-1) inhibitors compared to second-line chemotherapy in treating esophageal squamous cell carcinoma (ESCC). However, there is a lack of economic comparisons among the different PD-1 inhibitors.

Aim: This study aimed to assess the cost-effectiveness of PD-1 inhibitors (nivolumab, pembrolizumab, camrelizumab, and tislelizumab) in second-line treatment for advanced or metastatic ESCC within the Chinese healthcare system.

Method: The clinical trials were systematically retrieved from PubMed, Embase, Web of Science, and the Cochrane Library. We established a fractional polynomials model to conduct a network meta-analysis, enabling the calculation of hazard ratios and expected survival rates. Economic outcomes were estimated using a partitioned survival model. The costs and utilities were gathered from published sources. The threshold for willingness-to-pay (WTP) for a quality-adjusted life year (QALY) was set at three times China's per capita gross domestic product in 2022. Sensitivity analyses (SA) were performed to address uncertainties in the model.

Results: Four phase III randomized controlled trials were included, evaluating the cost-effectiveness of four PD-1 inhibitors, camrelizumab, nivolumab, tislelizumab, and pembrolizumab, compared to chemotherapy for the second-line treatment of advanced or metastatic ESCC. For camrelizumab, nivolumab, tislelizumab, and pembrolizumab, the corresponding incremental cost-effectiveness ratios were $27,375.43/QALY, $205,312.19/QALY, $9,266.73/QALY, and $220,368.10/QALY, respectively. The SA results indicated the robustness of the base analysis findings.

Conclusion: From the Chinese healthcare system, under the WTP of $38,253.48/QALY, tislelizumab is a cost-effective treatment option for the second-line treatment of advanced or metastatic ESCC.

Keywords: Camrelizumab; Cost-effectiveness; Esophageal squamous cell carcinoma; Nivolumab; Tislelizumab.