First-line immunotherapy combinations for recurrent or metastatic nasopharyngeal carcinoma: An updated network meta-analysis and cost-effectiveness analysis

Jiaqi Han; Ni Zeng; Kun Tian; Zijian Liu; Longjiang She; Zhu Wang; Jinlan He; Nianyong Chen

doi:10.1002/hed.27452

First-line immunotherapy combinations for recurrent or metastatic nasopharyngeal carcinoma: An updated network meta-analysis and cost-effectiveness analysis

Head Neck. 2023 Sep;45(9):2246-2258. doi: 10.1002/hed.27452. Epub 2023 Jul 12.

Authors

Jiaqi Han^{1

2

3}, Ni Zeng^{1

2

3}, Kun Tian^{4

5}, Zijian Liu^{1

2

3}, Longjiang She⁶, Zhu Wang⁷, Jinlan He^{1

2

3}, Nianyong Chen^{1

2

3}

Affiliations

¹ Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
² Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
³ Laboratory of Liquid Biopsy and Single Cell Research, West China Hospital, Sichuan University, Chengdu, China.
⁴ Department of Andrology/Sichuan Human Sperm Bank, West China Second University Hospital, Sichuan University, Chengdu, China.
⁵ Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
⁶ Department of Radiation Oncology, First People's Hospital of Foshan, Foshan, China.
⁷ Laboratory of Molecular Diagnosis of Cancer, West China Hospital of Sichuan University, Chengdu, China.

PMID: 37435624
DOI: 10.1002/hed.27452

Abstract

Objectives: Recently updated results of randomized clinical trials (RCTs) have confirmed that toripalimab, camrelizumab, and tislelizumab plus chemotherapy (TOGP, CAGP, and TIGP) significantly prolonged survival compared to placebo plus chemotherapy (PLGP) in the first-line treatment for recurrent or metastatic nasopharyngeal carcinoma (R/M-NPC). However, the high cost of immunotherapies imposes a huge financial burden on patients and health care systems.

Materials and methods: RCTs estimating immunotherapies for R/M-NPC were searched. A Bayesian network meta-analysis (NMA) was carried out; the main outcomes were hazard ratios (HRs) of overall survival (OS) and progression-free survival (PFS). The cost and efficacy of four first-line therapies were evaluated using the Markov model. The main outcome in the cost-effectiveness analysis (CEA) was incremental cost-utility ratios (ICURs). The model robustness was assessed by one-way, three-way, and probabilistic sensitivity analyses.

Results: Three RCTs (JUPITER-02, CAPTAIN-1st, and RATIONALE-309) involving 815 patients were included in the NMA. Compared with PLGP, chemo-immunotherapies have significantly longer PFS and OS. Compared to the PLGP group, TOGP, CAGP, and TIGP groups resulted in additional costs of $48 339, $22 900, and $23 162, with additional 1.89, 0.73, and 0.960 QALYs, respectively, leading to the ICURs of $25 576/QALY, $31 370/QALY, and $31 729/QALY. Pairwise comparisons showed TOGP was the most cost-effective option among chemo-immunotherapy groups.

Conclusion: From the Chinese payers' perspective, first-line immunotherapy combination therapies provided significant survival and cost-effectiveness superiority over chemotherapy alone for patients with R/M-NPC at the WTP of $38 029/QALY. Among the three chemo-immunotherapy groups, TOGP was the most cost-effective option.

Keywords: camrelizumab; cost-effectiveness; immunotherapy; network meta-analysis; recurrent or metastatic nasopharyngeal carcinoma; tislelizumab; toripalimab.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Antineoplastic Combined Chemotherapy Protocols / therapeutic use
Cost-Benefit Analysis
Cost-Effectiveness Analysis*
Humans
Immunotherapy
Nasopharyngeal Carcinoma / therapy
Nasopharyngeal Neoplasms* / drug therapy
Neoplasm Recurrence, Local / therapy
Network Meta-Analysis