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Cost-effectiveness analysis of PD-1 inhibitors as second-line therapy for advanced or metastatic esophageal squamous cell carcinoma in China: an economic evaluation based on network meta-analysis

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Abstract

Background

Several economic studies have assessed the cost-effectiveness of programmed cell death protein-1 (PD-1) inhibitors compared to second-line chemotherapy in treating esophageal squamous cell carcinoma (ESCC). However, there is a lack of economic comparisons among the different PD-1 inhibitors.

Aim

This study aimed to assess the cost-effectiveness of PD-1 inhibitors (nivolumab, pembrolizumab, camrelizumab, and tislelizumab) in second-line treatment for advanced or metastatic ESCC within the Chinese healthcare system.

Method

The clinical trials were systematically retrieved from PubMed, Embase, Web of Science, and the Cochrane Library. We established a fractional polynomials model to conduct a network meta-analysis, enabling the calculation of hazard ratios and expected survival rates. Economic outcomes were estimated using a partitioned survival model. The costs and utilities were gathered from published sources. The threshold for willingness-to-pay (WTP) for a quality-adjusted life year (QALY) was set at three times China’s per capita gross domestic product in 2022. Sensitivity analyses (SA) were performed to address uncertainties in the model.

Results

Four phase III randomized controlled trials were included, evaluating the cost-effectiveness of four PD-1 inhibitors, camrelizumab, nivolumab, tislelizumab, and pembrolizumab, compared to chemotherapy for the second-line treatment of advanced or metastatic ESCC. For camrelizumab, nivolumab, tislelizumab, and pembrolizumab, the corresponding incremental cost-effectiveness ratios were $27,375.43/QALY, $205,312.19/QALY, $9,266.73/QALY, and $220,368.10/QALY, respectively. The SA results indicated the robustness of the base analysis findings.

Conclusion

From the Chinese healthcare system, under the WTP of $38,253.48/QALY, tislelizumab is a cost-effective treatment option for the second-line treatment of advanced or metastatic ESCC.

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Acknowledgements

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Funding

This study was not supported by project funds.

Author information

Author notes

  1. Shuang Liu and Linbo Zhao have contributed equally to this work.

Authors and Affiliations

  1. Hebei Key Laboratory of Neuropharmacology, Department of Pharmacy, Hebei North University, 11, South Diamond Road, Qiaodong District, Zhangjiakou, People’s Republic of China

    Shuang Liu & Linbo Zhao

  2. International Research Center for Medicinal Administration, Peking University, 38, Xueyuan Road, Haidian District, Bei**g, People’s Republic of China

    Fenghao Shi

  3. Science and Technology Development Center of Chinese Pharmaceutical Association, 38, Yongda Road, Daxing District, Bei**g, People’s Republic of China

    Li** Kuai

  4. Department of Pharmacy, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 33, Yingfeng Road, Haizhu District, Guangzhou, People’s Republic of China

    Ruizhe Liu

  5. Institute of Disaster and Emergency Medicine, Tian** University, 92, Wei** Road, Nankai District, Tian**, People’s Republic of China

    Jianhua Tang

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Liu, S., Zhao, L., Shi, F. et al. Cost-effectiveness analysis of PD-1 inhibitors as second-line therapy for advanced or metastatic esophageal squamous cell carcinoma in China: an economic evaluation based on network meta-analysis. Int J Clin Pharm 46, 675–683 (2024). https://doi.org/10.1007/s11096-023-01696-5

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