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Immune checkpoint inhibitors plus chemotherapy for HER2-negative advanced gastric/gastroesophageal junction cancer: a cost-effectiveness analysis.
Therapeutic Advances in Gastroenterology ( IF 4.2 ) Pub Date : 2023-11-02 , DOI: 10.1177/17562848231207200 Youwen Zhu 1 , Kun Liu 1 , Hong Zhu 1, 2 , Haijun Wu 3, 4
Therapeutic Advances in Gastroenterology ( IF 4.2 ) Pub Date : 2023-11-02 , DOI: 10.1177/17562848231207200 Youwen Zhu 1 , Kun Liu 1 , Hong Zhu 1, 2 , Haijun Wu 3, 4
Affiliation
Background
Nivolumab plus chemotherapy (NC) was recently approved as the first-line intervention for human epidermal growth factor receptor 2-negative advanced gastric/gastroesophageal junction cancer (GC/GEJC). Moreover, in the latest KEYNOTE-859 (NCT03675737), pembrolizumab plus chemotherapy (PC) was demonstrated to produce remarkable patient survival outcomes.
Objectives
The clinicians and patients need to assess NC and PC preference for cancer drugs.
Design
The cost-effective analysis.
Methods
In an economic assessment of the United States, United Kingdom, and Chinese healthcare systems using a Markov model simulated patients with GC/GEJC, two treatment decision branches with three health states and a tracked time horizon of 15 years were developed. The overall cost and efficacy outcomes of first-line strategies PC and NC were evaluated at willingness-to-pay (WTP) thresholds of different national, including life-years (LYs), quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and incremental net-health benefit (INHB). Sensitivity and subgroup analyses were considered.
Results
Given a WTP threshold of $150,000, $60,161, and $37,653 per QALY in the United States, United Kingdom, and China, respectively, both PC and NC achieved QALYs of 1.67 and 1.65 (2.51 and 2.48 LYs), 1.65 and 1.63 (2.48 and 2.45 LYs), and 1.60 and 1.58 (2.40 and 2.37 LYs), with total costs of $242,444 and $232,617, $148,367 and $127,737, and $16,693 and $24,016, respectively. Based on our sensitivity analysis, the programmed death-1 inhibitors cost produced the largest impact on the outcome. In addition, the cost-effectiveness probabilities of PC were 38.3%, 4.1%, and 100% in the three aforementioned countries, respectively.
Conclusion
In the case of the Chinese payers' perspective, PC appeared more dominant as first-line therapy for advanced GC/GEJC patients, whereas NC was preferred in the United States and United Kingdom.
更新日期：2023-11-02
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