Cost-Effectiveness Analysis of Camrelizumab vs. Placebo Added to Chemotherapy as First-Line Therapy for Advanced or Metastatic Esophageal Squamous Cell Carcinoma in China.

Qilin Zhang,Xucheng He,Pan Wu,Yamin Shu,Yufeng Ding

doi:10.3389/fonc.2021.790373

Abstract

ObjectiveThe purpose of this cost-effectiveness analysis was to estimate the effects of adding camrelizumab to standard chemotherapy as the first-line treatment in patients with advanced or metastatic esophageal squamous cell carcinoma (ESCC) on health and economic outcomes in China.MethodsA Markov model was developed to simulate the clinical course of typical patients with advanced or metastatic ESCC in the ESCORT-1st trial. Weibull survival model was employed to fit the Kaplan-Meier progression-free survival and overall survival probabilities of the camrelizumab-chemotherapy and placebo-chemotherapy strategy, respectively. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICER) were estimated over a 5-year lifetime horizon. Meanwhile, one-way and probabilistic sensitivity analyses were conducted to test the uncertainty in the model.ResultsOn baseline analysis, the incremental effectiveness and cost of camrelizumab-chemotherapy versus placebo-chemotherapy were 0.15 QALYs and $7,110.56, resulting in an ICER of $46,671.10/QALY, higher than the willingness-to-pay (WTP) threshold of China ($31,498.70/QALY). The results were sensitive to the utility of PFS and cost of camrelizumab.ConclusionThe findings from the present analysis suggest that the addition of camrelizumab to chemotherapy might not be cost-effective in patients with advanced or metastatic ESCC in China.

Highlights

Esophageal cancer is the seventh most frequently diagnosed malignant cancer and ranks sixth in mortality worldwide [1]
At the Chinese cost-effectiveness WTP threshold of $31,498.70/quality-adjusted life-years (QALYs), camrelizumab-chemotherapy was not a cost-effective treatment strategy compared with placebo-chemotherapy
In the tornado diagram of one-way sensitivity analysis (Figure 3), the most influential variables were the utility of progression-free survival (PFS) and the cost of camrelizumab per 200 mg

Summary

Introduction

Esophageal cancer is the seventh most frequently diagnosed malignant cancer and ranks sixth in mortality worldwide [1]. China has a high incidence of esophageal cancer, accounting for more than 50% of the global morbidity and mortality [2]. Esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) are the two major histological types of esophageal cancer. In China, approximately 90% of esophageal cancer patients are diagnosed with ESCC [3]. Palliative chemotherapy regiments, including fluorouracil plus platinum, and paclitaxel plus platinum, are the current recommended standard first-line therapy for patients with unresectable advanced, relapsed or metastatic ESCC [4]. The prognosis of patients with advanced ESCC is still poor. New treatment options for patients with advanced or metastatic ESCC are urgently needed

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Discussion

Conclusion