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Pembrolizumab Plus Chemotherapy as First-Line Treatment for Advanced Esophageal Cancer: A Cost-Effectiveness Analysis

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Abstract

Introduction

In 2021, KEYNOTE-590 (NCT03189719) showed that pembrolizumab plus 5-fluorouracil and cisplatin (PPF) has more benefits than 5-fluorouracil and cisplatin (PF) as a first-line regimen to treat individuals with advanced esophageal cancer. However, given that it is expensive, controversies over the value of using this compared to competitive strategies remain. Hence, we conducted a cost-effectiveness evaluation of pembrolizumab plus chemotherapy.

Methods

A Markov model was applied in evaluating the efficacy and cost of PPF and PF over a 7-year horizon and measured the health outcomes in life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). The economic data included were relevant to patients in the USA and China. We also performed one-way and probabilistic sensitivity analyses to determine the uncertainties relevant to the model. Willingness to pay thresholds (WTP) of $150,000/QALY (USA) and $35,673/QALY (China) were used to calculate a probability for the cost-effectiveness of PPF.

Results

PPF yielded 0.386–0.607 QALYs (0.781–1.195 LYs) compared with PF. In our analysis, compared with receiving PF, patients with advanced esophageal cancer receiving PPF had an ICER of $577,461/QALY in the USA and $258,261/QALY in China, those for esophageal squamous cell carcinoma were $550,211/QALY in the USA and $244,580/QALY in China, and a programmed cell death ligand 1 combined positive score (PD-L1 CPS) ≥ 10 was associated with a cost of $479,119/QALY in the USA and $201,355/QALY in China. Sensitivity analysis found the price of pembrolizumab to be the biggest influence.

Conclusion

From the economic perspectives of the USA and China, a first-line regimen of PPF for esophageal cancer therapy may not be as cost-effective as PF. However, patients with esophageal cancer and PD-L1 CPS ≥ 10 may gain the most LYs from initial PPF treatment.

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Acknowledgements

Funding

No funding or sponsorship was received for this study or publication of this article. The journal’s Rapid Service Fee was funded by the authors.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors; it does not require the approval of the independent ethics committee.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Author Contributions

Youwen Zhu, Kun Liu, Dong Ding, Yangying Zhou, and Libo Peng performed the experiments. Youwen Zhu, Kun Liu, Dong Ding, and Libo Peng analyzed the data. Libo Peng contributed materials and analysis tools. Youwen Zhu, Kun Liu, Dong Ding, Yangying Zhou, and Libo Peng wrote the manuscript. Youwen Zhu and Kun Liu contributed equally to this article. All authors have read and approved the manuscript.

Disclosures

Youwen Zhu, Kun Liu, Dong Ding, Yangying Zhou, and Libo Peng confirm that they have no competing interests in the content of the article. This manuscript is original and has not been previously published, nor has it been simultaneously submitted to any other journal.

Data Availability

All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis. The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author notes

  1. Youwen Zhu and Kun Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Oncology, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China

    Youwen Zhu, Kun Liu & Yangying Zhou

  2. Department of Oncology, Enshi Central Hospital, Wuhan University, Hubei, 445000, China

    Dong Ding

  3. Department of Oncology, The Central Hospital of Loudi, The University of South China, Loudi, 417000, Hunan, China

    Libo Peng

  4. Department of Oncology, The Central Hospital of Loudi Affiliated to the University of South China, Loudi, 417000, Hunan, China

    Libo Peng

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  1. Youwen Zhu
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  5. Libo Peng
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Corresponding author

Correspondence to Libo Peng.

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Zhu, Y., Liu, K., Ding, D. et al. Pembrolizumab Plus Chemotherapy as First-Line Treatment for Advanced Esophageal Cancer: A Cost-Effectiveness Analysis. Adv Ther 39, 2614–2629 (2022). https://doi.org/10.1007/s12325-022-02101-9

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  • DOI: https://doi.org/10.1007/s12325-022-02101-9

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