Cost-effectiveness analysis of nivolumab combination therapy in the first-line treatment for advanced esophageal squamous-cell carcinoma

Shixian Liu; Lei Dou; Kaixuan Wang; Zhao Shi; Ruixue Wang; Xiaohong Zhu; Zehua Song; Shunping Li

doi:10.3389/fonc.2022.899966

Cost-effectiveness analysis of nivolumab combination therapy in the first-line treatment for advanced esophageal squamous-cell carcinoma

Front Oncol. 2022 Jul 22:12:899966. doi: 10.3389/fonc.2022.899966. eCollection 2022.

Authors

Shixian Liu^{1

2

3}, Lei Dou^{1

2

3}, Kaixuan Wang^{1

2

3}, Zhao Shi^{1

2

3}, Ruixue Wang^{1

2

3}, Xiaohong Zhu^{1

2

3}, Zehua Song^{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 National Health Commission (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China.
³ Center for Health Preference Research, Shandong University, Jinan, China.

Abstract

Objective: We aimed to investigate the cost-effectiveness of nivolumab plus chemotherapy and nivolumab plus ipilimumab versus chemotherapy in the first-line treatment for advanced esophageal squamous-cell carcinoma (ESCC) patients from a healthcare system perspective in China.

Methods: On the basis of the CheckMate 648 trial, a partitioned survival model was constructed to estimate economic costs and health outcomes among overall and PD-L1-positive advanced ESCC patients over a 10-year lifetime horizon. The health-related costs and utilities were obtained from the local charges and published literature. The lifetime costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) were measured. One-way and probabilistic sensitivity analyses (PSA) were performed to assess the robustness of the model.

Results: In the base-case analysis, in overall and PD-L1-positive advanced ESCC patients, the ICERs were $415,163.81/QALY and $216,628.00/QALY for nivolumab plus chemotherapy, and$430,704.11/QALY and $185,483.94/QALY for nivolumab plus ipilimumab, respectively, compared with chemotherapy. One-way sensitivity analyses revealed that patients' weight was the most influential parameter on ICER. The PSA demonstrated that the probability of nivolumab combination therapy being cost-effective was 0% over chemotherapy at the current price and willingness-to-pay threshold ($38,351.20/QALY). When the price of nivolumab and ipilimumab decreased 80%, the cost-effective probability of nivolumab plus ipilimumab increased to 40.44% and 86.38% in overall and PD-L1-positive advanced ESCC patients, respectively.

Conclusion: Nivolumab combination therapy could improve survival time and health benefits over chemotherapy for advanced ESCC patients, but it is unlikely to be a cost-effective treatment option in China.

Keywords: chemotherapy; cost-effectiveness; esophageal squamous-cell carcinoma; first-line treatment; ipilimumab; nivolumab.