Real-World Cost-Effectiveness Analysis of Gemcitabine and Cisplatin Compared to Docetaxel and Cisplatin Plus Fluorouracil Induction Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma.

Jiangping Yang,Feng Wang,Yanchu Li,Jiaqi Han,Kexing Ren,Qiheng Gou,Min Yao,Baofeng Duan,Nianyong Chen,Ping Ai,Lei Liu,Jinlan He

doi:10.3389/fonc.2020.594756

Abstract

BackgroundAddition of gemcitabine and cisplatin (GP) or docetaxel and cisplatin plus fluorouracil (TPF) to concurrent chemoradiotherapy (CCRT) signiﬁcantly improved survival in locoregionally advanced nasopharyngeal carcinoma (NPC). However, an economic evaluation of these regimens remains unknown. The purpose of this study is to compare the cost-effectiveness of GP versus TPF regimen in the treatment of locoregionally advanced NPC in China.Materials and methodsA comprehensive Markov model was developed to evaluate the health and economic outcomes of GP versus TPF regimen for patients with locoregionally advanced NPC. Baseline and clinical outcome were derived from 158 patients with newly diagnosed stage III-IVA NPC between 2010 and 2015. We evaluated the quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) from the perspective of the Chinese healthcare system. One-way sensitive analysis explored the impact of uncertainty in key model parameters on results, and probabilistic uncertainty was assessed through a Monte Carlo probabilistic sensitivity analysis.ResultsGP regimen provided an additional 0.42 QALYs with incremental cost of $3,821.99, resulting in an ICER of $9,099.98 per QALY versus TPF regimen at the real-world setting. One-way sensitivity analysis found that the results were most sensitive to the cost and proportion of receiving subsequent treatment in two groups. The probability that GP regimen being cost-effective compared with TPF regimen was 86.9% at a willingness-to-pay (WTP) of $31,008.16 per QALY.ConclusionUsing real-world data, GP regimen was demonstrated a cost-effective alternative to TFP regimen for patients with locoregionally advanced NPC in China. It provides valuable evidence for clinicians when making treatment decisions to improve the cost-effectiveness of treatment.

Highlights

Nasopharyngeal carcinoma (NPC) is endemic in southern China and countries in Southeast Asia with around 129,000 new cases and 73,000 disease-related deaths occurred in 2018 [1, 2]
158 patients were included for analysis, including 71 patients (44.9%) in the gemcitabine and cisplatin (GP) group and 87 patients (55.1%) in the TPF group, respectively
The baseline characteristics of patients in the model were derived from the relevant data of our previous study [15]

Summary

Introduction

Nasopharyngeal carcinoma (NPC) is endemic in southern China and countries in Southeast Asia with around 129,000 new cases and 73,000 disease-related deaths occurred in 2018 [1, 2]. Previous randomized phase 3 trials of adding docetaxel and cisplatin plus fluorouracil (TPF) prior to CCRT have significantly prolonged 3-year over survival (OS), failure free survival with acceptable toxicity in patients with locoregionally advanced NPC [9,10,11]. GP plus CCRT significantly improved 3-year recurrence-free survival and OS among patients with high-risk locoregionally advanced NPC compared to CCRT alone in a multicenter, randomized, phase III trial [13]. Based on these encouraging results, sequential GP and TPF regimen followed by CCRT have been both included as preferred choices for IC by the National Comprehensive Cancer Network (NCCN) [14].

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