Cost-Effectiveness Analysis of Camrelizumab Versus Chemotherapy as Second-Line Treatment of Advanced or Metastatic Esophageal Squamous Cell Carcinoma

Hongfu Cai,Zhiwei Zheng,Baohua Xu,Bin Zheng,Maobai Liu,Na Li

doi:10.3389/fphar.2021.732912

Abstract

Background: This study aimed to analyze the cost effectiveness of camrelizumab in the second-line treatment of advanced or metastatic esophageal squamous cell carcinoma in China. Methods: On the basis of the ESCORT clinical trial, a partitioned survival model was constructed to simulate the patient’s lifetime quality-adjusted life years (QALYs), lifetime costs, and incremental cost-effectiveness ratio (ICER). One-way sensitivity and probability sensitivity analyses were performed to test the stability of the model. Results: Treatment of esophageal squamous cell carcinoma with camrelizumab added 0.36 QALYs and resulted in an incremental cost of $1,439.64 compared with chemotherapy, which had an ICER of $3,999 per QALY gained. The ICER was far lower than the threshold of willingness to pay for one time the GDP per capita in China. Sensitivity analysis revealed that the ICERs were most sensitive to the cost of drugs, but the parameters did not have a major effect on the results of the model. Conclusion: Camrelizumab is likely to be a cost-effective option compared with chemotherapy for patients with advanced or metastatic esophageal squamous cell carcinoma. This informs patient selection and clinical path development.

Highlights

The world has approximately 572,000 new cases of esophageal cancer and 508,000 deaths every year
The relative 5-year survival rate is 8% or less for patients diagnosed with metastatic disease; the time horizon of the model was set to 10 years (ASCO, 2020; Cancer Information Service, 2020)
The ICER was far less than the WTP threshold of one time the GDP ($10503.52/QALY), that is, the camrelizumab group had an absolute cost-effective advantage

Summary

Introduction

The world has approximately 572,000 new cases of esophageal cancer and 508,000 deaths every year. The number of new cases of and deaths from esophageal cancer in China ranks sixth and fourth places among all malignant tumors, respectively (Sung et al, 2021). Esophageal squamous cell carcinoma accounts for more than 90% of esophageal cancer (Arnold et al, 2015). The incidence of esophageal squamous cell carcinoma is increasing in some Asian countries. Half of the global esophageal squamous cell carcinoma cases occur in China (Zhang et al, 2012; Sung et al, 2021).

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