Cost-effectiveness of camrelizumab combined with chemotherapy in the first-line treatment of recurrent or metastatic nasopharyngeal carcinoma in China

• Published in: BMJ open 2023-12, Vol.13 (12), p.e071832-e071832
• Main Authors: Zhao, Ziying, Chen, Tongfeng, Zhou, Zhen, Guo, Rui, Liu, Qiao
• Format: Article
• Language: English
• Subjects: Cancer; Chemotherapy; China; Clinical Decision-Making; Clinical trials; Cost analysis; Head & neck cancer; Head & neck tumours; Health care; Health Economics; Markov chains; Medical prognosis; Metastasis; Oncology; Palliative care; Probability; PUBLIC HEALTH; Sensitivity analysis; Software; Throat cancer
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-071832

ObjectiveThis study aimed to investigate the cost-effectiveness of adding Chinese-developed anti-PD-1 antibody camrelizumab to first-line platinum-doublet chemotherapy in patients with recurrent or metastatic nasopharyngeal carcinoma (L/M NPC) from the perspective of Chinese healthcare system.DesignA Markov model consisting of four health states, progression-free survival, first progression survival, second progression survival and death, was built to simulate 3-week patient transitions over a 20-year horizon. A direct comparison between first-line camrelizumab in combination with gemcitabine plus cisplatin and gemcitabine plus cisplatin was performed by calculating transition probabilities from the CAPTAIN-1st trial. Costs and utilities were collected from the local public database and literature. One-way and probabilistic sensitivity analyses were employed to evaluate the robustness of the model.SettingThe Chinese healthcare system perspective.ParticipantsA hypothetical cohort of Chinese patients with pathologically diagnosed L/M NPC who had an Eastern Cooperative Oncology Group performance status of 0 or 1.InterventionsFirst-line camrelizumab in combination with camrelizumab and gemcitabine plus cisplatin (CGP) versus gemcitabine plus cisplatin (GP).Primary outcome measureCost, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER).ResultsThe baseline analysis demonstrated that, compared with first-line GP, first-line CGP yields an effectiveness increase of 0.26 QALY, accompanied by an increment of US$6137.59 in healthcare cost. This results in an ICER of US$23 482.32/QALY. With the willingness-to-pay (WTP) threshold for a QALY set at US$37 654.50, first-line CGP proves to be cost-effective in 97.20% of the iterations. Deterministic sensitivity analyses indicated that the uncertainty in model parameters had no substantial effect on our results. Probability sensitivity analysis indicated that CGP was cost-effective at the assumed WTP threshold.ConclusionFor Chinese patients with L/M NPC, adding Chinese-developed anti-PD-1 antibody camrelizumab to the first-line GP chemotherapy may be cost-effective.