109P - Economic evaluation of second-line treatment for patients with esophageal squamous cell carcinoma: A systematic review

Background

Squamous cell carcinoma accounts for about 90% of the 456,000 incident esophageal cancers each year. The aim of the current systematic literature review (SLR) was to summarize the economic evaluations in the second or further-line treatment of esophageal squamous cell carcinoma (ESCC).

Methods

An SLR was performed across major biomedical databases (Embase, Medline, and NHS EED) to identify studies reporting economic evaluations for second line treatment of advanced metastatic ESCC.

Results

The SLR identified 535 hits through July 2022 and included 10 cost-effectiveness analysis (CEA). Eight studies were conducted in China and two in the US. Six Chinese studies used Markov model while partitioned survival model was used in two studies each in US and China. All studies used lifetime time horizon with discounting rate ranging from 3% to 5%. Nivolumab was a cost-effective treatment option in the US as compared to chemotherapy (CT) with an incremental cost-utility ratio (ICUR) of $143,400/QALY which remained below a willingness-to-pay threshold (WTP) of $195,000/QALY from payer’s perspective. Pembrolizumab was associated with both improved life-years and QALYS as compared to CT with an incremental cost effectiveness ratio (ICER) of $249,807 from healthcare perspective. Across the 8 Chinese studies, four studies assessed CEA of camrelizumab, three pembrolizumab and one nivolumab. Chinese healthcare system perspective was used in majority of the studies. Three studies reported camrelizumab was cost-effective as compared to CT with an ICER of $3,999, $9,292, and USD18,393 per QALY. Camrelizumab was not cost-effective in one study compared with CT with an ICER of US$86,745 per QALY (WTP = US$30,094/QALY). Pembrolizumab was a cost-effective treatment with an ICER of USD26,757/QALY while it was not a cost-effective option in two studies. Nivolumab was also found to be cost-effective treatment compared to CT with an ICER of $136,709/QALY.

Conclusions

Nivolumab and pembrolizumab can be life-extending and cost-effective second-line treatment option for advanced, metastatic ESCC patients while camrelizumab was also proven to be cost-effective in China.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Pharmacoevidence Private Limited.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.