Chemo-Immunotherapy Regimes for Recurrent or Metastatic Nasopharyngeal Carcinoma: A Network Meta-Analysis and Cost-Effectiveness Analysis

被引:20
|
作者
Zhu, Youwen [1 ]
Liu, Kun [1 ]
Ding, Dong [2 ]
Wang, Kailing [3 ]
Liu, Xiaoting [4 ]
Tan, Xiao [1 ]
机构
[1] Cent South Univ, Xiangya Hosp, Dept Oncol, Changsha, Peoples R China
[2] Wuhan Univ, Enshi Cent Hosp, Dept Oncol, Wuhan, Hubei, Peoples R China
[3] Cent South Univ, Xiangya Hosp, Dept Gastroenterol, Changsha, Peoples R China
[4] Brain Hosp Hunan Prov, Hlth Management Ctr, Changsha, Peoples R China
基金
中国国家自然科学基金;
关键词
recurrent or metastatic nasopharyngeal carcinoma; toripalimab; camrelizumab; gemcitabine and cisplatin; cost-effectiveness; SQUAMOUS-CELL CARCINOMA; OPEN-LABEL; 1ST-LINE TREATMENT; SURVIVAL ANALYSIS; NECK-CANCER; HEAD; CHEMOTHERAPY; PEMBROLIZUMAB; NIVOLUMAB; CAMRELIZUMAB;
D O I
10.3389/fphar.2022.858207
中图分类号
R9 [药学];
学科分类号
1007 ;
摘要
Introduction: In 2021, two phase III clinical trials confirmed that toripalimab or camrelizumab combined with gemcitabine and cisplatin (TGP or CGP) provide more benefits in the first-line treatment of R/M NPC than GP. Fortunately, TGP and CGP were recently approved as first-line treatments for cases experiencing R/M NPC by the China National Medical Products Administration in 2021. However, due to the high cost and variety of treatment options, the promotion of chemo-immunotherapeutics in the treatment of R/M NPC remains controversial. Therefore, we performed a cost-effectiveness assessment of the two newly approved treatment strategies to assess which treatments provide the greatest clinical benefits at a reasonable cost.Methods: A cost-effectiveness analysis and network meta-analysis network meta-analysis was conducted based on the JUPITER-02 and CAPTAIN-first Phase 3 randomized clinical trials. A Markov model was expanded for the evaluation of the effectiveness and cost of TGP, CGP, and GP chemotherapy with a 10-years horizon and measured the health achievements in quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and life-years (LYs). We constructed a treatment strategy and other parameters based on two clinical trials and performed one-way and probabilistic sensitivity experiments for the evaluation of the uncertainty in the model.Results: For the model of patients with treatment-R/M NPC, TGP was associated with a total cost of $48,525 and 2.778 QALYs (4.991 LYs), leading to an ICER of $15,103 per QALY ($10,321 per LY) compared to CGP. On comparing the GP chemotherapy, we found TGP and CGP incurred substantial health costs, resulting in ICERs of $19,726 per QALY and $20,438 per QALY, respectively. The risk of adverse events (AEs) and the price of the drugs had significant impacts on the ICER. At the assumed willingness-to-pay (WTP) threshold of $35,673 per QALY, there were approximately 75.8 and 68.5% simulations in which cost-effectiveness was achieved for TGP and CGP, respectively.Conclusion: From the Chinese payer's perspective, TGP is more possible to be a cost-effective regimen compared with CGP and GP for first-line treatment of patients with R/M NPC at a WTP threshold of $35,673 per QALY.
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页数:10
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