Cost-effectiveness analysis of dostarlimab plus carboplatin-paclitaxel as first-line treatment for advanced endometrial cancer

Maojin You; Xiaoling Zeng; Jinrong Zhang; Yufan Huang; Yalan Zhang; Zhongjie Cai; Yingying Hu

doi:10.3389/fimmu.2023.1267322

Cost-effectiveness analysis of dostarlimab plus carboplatin-paclitaxel as first-line treatment for advanced endometrial cancer

Front Immunol. 2023 Sep 4:14:1267322. doi: 10.3389/fimmu.2023.1267322. eCollection 2023.

Authors

Maojin You¹, Xiaoling Zeng², Jinrong Zhang¹, Yufan Huang¹, Yalan Zhang³, Zhongjie Cai¹, Yingying Hu⁴

Affiliations

¹ Department of Pharmacy, Mindong Hospital Affiliated to Fujian Medical University, Ningde, Fujian, China.
² Department of Pharmacy, The Second Hospital of Zhangzhou, Zhangzhou, Fujian, China.
³ Department of Pharmacy, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China.
⁴ Department of Pharmacy, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China.

Abstract

Background: A recent phase III clinical trial (NCT03981796) evaluated the efficacy and safety of dostarlimab combined with carboplatin-paclitaxel (DOS-CP) compared to placebo combined with carboplatin-paclitaxel (PLB-CP) as a first-line treatment for advanced endometrial cancer (EC). The NCT03981796 trial demonstrated that DOS-CP significantly improved progression-free survival and overall survival of patients with advanced EC while maintaining an acceptable safety profile. However, DOS-CP is expensive and its cost-effectiveness has not been evaluated. This study aims to evaluate the cost-effectiveness of DOS-CP compared to PLB-CP as a first-line treatment for advanced EC from the perspective of the Chinese healthcare system.

Methods: A Markov model with three health states was developed to evaluate the cost-effectiveness of DOS-CP as a first-line treatment for advanced EC. Clinical efficacy data were derived from the NCT03981796 trial, and drug costs were determined based on national tender prices. Other costs and utility values were obtained from published literature. The outcomes assessed included total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). The robustness of the model was assessed through one-way sensitivity analysis and probabilistic sensitivity analysis.

Results: In comparison to PLB-CP, the ICER of DOS-CP was $98,276.61/QALY for the overall population, $53,063.61/QALY for the dMMR subgroup, and $124,088.56/QALY for the pMMR subgroup. All of these ICER values were higher than the willingness-to-pay threshold of $38,201 per QALY. The most important variable that affected the results of the model was the discount rate, the cost of dostarlimab, and the utility value for progressive disease.

Conclusion: From the perspective of the Chinese healthcare system, DOS-CP is unlikely to be a cost-effective first-line treatment option for advanced EC.

Keywords: carboplatin-paclitaxel; cost-effectiveness; dostarlimab; endometrial cancer; first-line treatment.

Publication types

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

MeSH terms

Antibodies, Monoclonal, Humanized
Carboplatin / therapeutic use
Cost-Effectiveness Analysis*
Endometrial Neoplasms* / drug therapy
Female
Humans

Substances

Antibodies, Monoclonal, Humanized
Carboplatin
dostarlimab

Associated data

ClinicalTrials.gov/NCT03981796

Grants and funding

This study was supported in part by grants from the Natural Science Foundation of Fujian Province (Grant number: 2021J011288; 2023J011910); Startup Fund for scientific research, Fujian Medical University (Grant number: 2021QH1203); Natural Science Foundation of Ningde (Grant number: 2022J29); Mindong Hospital Science Fund (Grant number: 2022YN005). This study was not supported by any pharmaceutical company.