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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