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Original Research

Cost-effectiveness of camrelizumab plus chemotherapy versus chemotherapy alone as first-line therapy in advanced or metastatic esophageal squamous cell carcinoma

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Pages 709-717 | Received 08 Mar 2023, Accepted 06 May 2023, Published online: 23 May 2023
 

ABSTRACT

Objective

Camrelizumab combination therapy for advanced or metastatic esophageal squamous cell carcinoma (ESCC) has considerable survival benefits. This study investigated the cost-effectiveness of camrelizumab combination therapy versus chemotherapy alone as a first-line treatment for patients with ESCC from the perspective of the Chinese healthcare system.

Methods

A three-state partitioned survival model was developed to estimate total costs, life years (LYs), quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs) and incremental net health benefits (INHBs) over a 20-year time horizon. Sensitivity and scenario analyses were also performed.

Results

Camrelizumab plus chemotherapy increased QALYs by 0.30 (0.43 LYs), with an incremental cost of $9,272. The ICERs for camrelizumab plus chemotherapy vs chemotherapy alone was $31,062/QALY ($21,599/LY), and the INHB was 0.05 QALY at the cost-effective threshold of $37,653/QALY (3 times China’s GDP per capita). One-way sensitivity analyses showed that the ICER was the most sensitive to utility values in the PFS state. Probabilistic sensitivity analyses suggested that camrelizumab combination therapy had a probability of 74.04% cost-effectiveness at a threshold of $37,653/QALY. Scenario analyses confirmed that the findings were robust.

Conclusions

Camrelizumab combination therapy is likely to have a cost-effectiveness advantage over chemotherapy alone for previously untreated advanced or metastatic ESCC in China.

Article highlights

  • China, one of the largest developing countries in the world, is experiencing an increasing economic burden due to esophageal cancer.

  • Domestic ICIs camrelizumab could improve survival time and health benefits for advanced ESCC patients.

  • The ICER of camrelizumab plus chemotherapy versus chemotherapy was $31,062/QALY, which was below the threshold of three times the GDP per capita.

  • Camrelizumab plus chemotherapy is likely a cost-effective first-line treatment to enable ESCC patients with advanced-stage receive proper treatment in China.

  • A further price decline (76.08% and 52.87% reduction) is required if a lower threshold (1× and 1.45× GDP per capita) is claimed.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

One peer reviewer is employed by Co-Bio Consulting LLC, and has received honoraria from, Janssen, Merck & Co., and Pfizer in the past 3 years. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Author contributions

G Liu, Z Sun and J Gong designed the study. J Gong, J Shang, D Su, and X Qian collected data. J Gong and J Shang analyzed and interpreted the data. J Gong wrote the first draft of the manuscript, which was subsequently revised by G Liu and Z Sun. All authors reviewed and approved the final version of the manuscript to be published. J Gong took responsibility for the integrity of data analysis.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials (https://www.tandfonline.com/doi/suppl/10.1080/14737167.2023.2214732). Further inquiries can be directed at the corresponding author.

SUPPLEMENTARY MATERIAL

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2214732

Additional information

Funding

This paper was funded by the Medical Pharmacy Fund of Jiangsu Pharmaceutical Association (No. Q202228); Jiangsu Research Hospital Association for Precision Medication (No. JY202236); and Changzhou Sci & Tech Program (No. CJ20229016).

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