Cost-effectiveness analysis of serplulimab plus chemotherapy in the first-line treatment for PD-L1-positive esophageal squamous cell carcinoma in China

Shixian Liu; Nana Jiang; Lei Dou; Shunping Li

doi:10.3389/fimmu.2023.1172242

Cost-effectiveness analysis of serplulimab plus chemotherapy in the first-line treatment for PD-L1-positive esophageal squamous cell carcinoma in China

Front Immunol. 2023 May 4:14:1172242. doi: 10.3389/fimmu.2023.1172242. eCollection 2023.

Authors

Shixian Liu^{1

2

3}, Nana Jiang⁴, Lei Dou^{1

2

3}, Shunping Li^{1

2

3}

Affiliations

¹ Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
² NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, China.
³ Center for Health Preference Research, Shandong University, Jinan, China.
⁴ Department of Maternal and Child Health, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.

Abstract

Objective: The ASTRUM-007 trial (NCT03958890) demonstrated that serplulimab plus chemotherapy administered every 2-week significantly improved progression-free and overall survival in patients with previously untreated, programmed death-ligand 1 (PD-L1) positive advanced esophageal squamous-cell carcinoma (ESCC). This study was aimed to investigate the cost-effectiveness of serplulimab plus chemotherapy in the first-line treatment of PD-L1-positive advanced ESCC.

Methods: A partitioned survival model with a 2-week cycle and a 10-year time horizon was constructed from the Chinese healthcare system perspective. The survival data, direct medical costs and utilities were derived from the ASTRUM-007 trial, YAOZHI database and published sources. Total costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. Scenario, one-way and probabilistic sensitivity analyses were performed to assess the uncertainty around model parameters.

Results: Compared with chemotherapy, serplulimab plus chemotherapy provided additional 0.27 QALYs with an incremental cost of $33,460.86, which had an ICER of $124,483.07 per QALY. The subgroup analyses revealed that the ICERs of serplulimab plus chemotherapy were $134,637.42 and $105,589.71 in advanced ESCC patients with 1 ≤ CPS < 10 and CPS ≥ 10, respectively. The price of serplulimab, patient weight, utility values and discount rate were the most influential parameters on base-case results. At a willingness-to-pay threshold of three times per capita GDP ($40,587.59) in 2022, the probability of serplulimab plus chemotherapy being cost-effective was 0% compared with chemotherapy. When the price of serplulimab decreased by 70%, the probabilities of serplulimab plus chemotherapy being cost-effective were 81.42%, 67.74% and 96.75% in advanced ESCC patients with PD-L1-positive, PD-L1 1≤CPS<10 and CPS≥10, respectively.

Conclusion: Serplulimab plus chemotherapy in the first-line treatment for PD-L1-positive advanced ESCC might not be cost-effective in China.

Keywords: cost-effectiveness; esophageal squamous-cell carcinoma; first-line; immunotherapy; serplulimab.

MeSH terms

Antibodies, Monoclonal / therapeutic use
Antibodies, Monoclonal, Humanized / therapeutic use
B7-H1 Antigen
Carcinoma, Non-Small-Cell Lung* / drug therapy
Cost-Benefit Analysis
Cost-Effectiveness Analysis
Esophageal Neoplasms* / drug therapy
Esophageal Squamous Cell Carcinoma* / drug therapy
Humans
Lung Neoplasms* / pathology

Substances

CD274 protein, human
B7-H1 Antigen
Antibodies, Monoclonal, Humanized
Antibodies, Monoclonal

Associated data

ClinicalTrials.gov/NCT03958890