Back
 PP  Vol.13 No.6 , June 2022
Cost-Utility Analysis of Nivolumab plus Chemotherapy in the First-Line Treatment of Upper Gastrointestinal Adenocarcinoma
Abstract: Objective: To evaluate the cost-utility of nivolumab plus chemotherapy compared with chemotherapy alone as the first-line treatment for advanced gastric, gastro-oesophageal junction, and esophageal adenocarcinoma in China. Methods: Based on CheckMate649, a partitioned survival model was carried out with a circulation cycle of 6 weeks to simulate the patient’s lifetime. Sensitivity analysis were adopted to verify the robustness of the results. Results: The results of the base-case analysis showed that both the total cost and utility of the nivolumab group were higher, and the ICUR value was CNY 267498.67/QALY, more than 3 times the GDP per capita of China in 2020. The results of deterministic sensitivity analysis indicated that the three most influential factors were the utility value of PFS state, the cost of nivolumab and the discount rate. The results of probabilistic sensitivity analysis were consistent with those of base-case analysis, proving that the results were robust. The scenario analysis illustrated that economical price of nivolumab was CNY 3652.71. Conclusions: Under the willing-to-pay threshold of three times the GDP per capita of China in 2020, compared with chemotherapy alone, nivolumab plus chemotherapy is not a cost-effective option in China.
Cite this paper: Fan, X. and Chen, Y. (2022) Cost-Utility Analysis of Nivolumab plus Chemotherapy in the First-Line Treatment of Upper Gastrointestinal Adenocarcinoma. Pharmacology & Pharmacy, 13, 212-224. doi: 10.4236/pp.2022.136017.
References

[1]   Sung, H., Ferlay, J., Siegel, R.L., Laversanne, M., Soerjomataram, I., Jemal, A. and Bray, F. (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 71, 209-249. https://doi.org/10.3322/caac.21660

[2]   Thrift, A.P. (2021) Global Burden and Epidemiology of Barrett Oesophagus and Oesophageal Cancer. Nature Reviews Gastroenterology & Hepatology, 18, 432-443. https://doi.org/10.1038/s41575-021-00419-3

[3]   Salem, M.E., Alberto, P., Xiu, J., Derek, R., Heinz-Josef, L., Michael, K.W., Shields, A.F., Philip, P.A., Marshall, J.L. and Goldberg, R.M. (2018) Comparative Molecular Analyses of Esophageal Squamous Cell Carcinoma, Esophageal Adenocarcinoma, and Gastric Adenocarcinoma. Oncologist, 23, 1319-1327.
https://doi.org/10.1634/theoncologist.2018-0143

[4]   Pape, M., Vissers, P.A.J., Bertwistle, D., Mcdonald, L., van Laarhoven, H.W.M. and Verhoeven, R.H. (2020) A Nationwide Population-Based Study Comparing Survival in Unresectable Advanced or Synchronous Metastatic Esophageal and Gastric Adenocarcinoma. Journal of Clinical Oncology, 38, 308.
https://doi.org/10.1200/JCO.2020.38.4_suppl.308

[5]   National Medical Products Administration (2021) Released Information for Drug Approval Documents to be Collected on August 30.
https://www.nmpa.gov.cn/zwfw/sdxx/sdxxyp/yppjfb/20210830130457154.html

[6]   Janjigian, Y.Y., Shitara, K., Moehler, M., Garrido, M., Salman, P., Shen, L., Wyrwicz, L., Yamaguchi, K., Skoczylas, T., Campos Bragagnoli, A., Liu, T., Schenker, M., Yanez, P., Tehfe, M., Kowalyszyn, R., Karamouzis, M.V., Bruges, R., Zander, T., Pazo-Cid, R., Hitre, E., Feeney, K., Cleary, J.M., Poulart, V., Cullen, D., Lei, M., Xiao, H., Kondo, K., Li, M. and Ajani, J.A. (2021) First-Line Nivolumab Plus Chemotherapy Versus Chemotherapy Alone for Advanced Gastric, Gastro-Oesophageal Junction, and Oesophageal Adenocarcinoma (CheckMate 649): A Randomised, Open-Label, Phase 3 Trial. The Lancet, 398, 27-40.
https://doi.org/10.1016/S0140-6736(21)00797-2

[7]   LIU, G.E. (2020) China Guidelines for Pharmaco-Economics Evaluations. China Market Press, Beijing, 27-46.

[8]   National Bureau of Statistics of China (2021) China Statistical Yearbook 2021. http://www.stats.gov.cn/tjsj/ndsj/2021/indexch.htm

[9]   Zeng, X.H., Peng, L.B., Li, J.H., Chen, G.N., Tan, C.Q., Wang, S.Y., Wan, X.M., Ouyang, L.H. and Zhao, Z.Y. (2013) Cost-Effectiveness of Continuation Maintenance Pemetrexed After Cisplatin and Pemetrexed Chemotherapy for Advanced Nonsquamous Non–Small-Cell Lung Cancer: Estimates From the Perspective of the Chinese Health Care System. Clinical Therapeutics, 35, 54-65.
https://doi.org/10.1016/j.clinthera.2012.12.013

[10]   Luo, X., Liu, Q., Yi, L.D., Peng, L.B., Tan, C.Q., Li, J.H., Li, S.N., Ma, F. and Zeng, X.H. (2021) Pharmacoeconomic Evaluation of Ramucirumab as a Single Agent Second-Line Chemotherapy for Advanced Gastric or Gastro-Oesophageal Junction Adenocarcinoma. Chinese Journal of New Drugs and Clinical Remedies, 40, 582-587.

[11]   Han, J.Q., She, L.J., Yao, L.L., Huang, J. (2019) Cost-Effectiveness Analysis of Nivolumab in Treatment of Chemotherapy-Refractory Advanced Gastric Cancer Based on Markov Model. Chinese Journal of General Surgery, 28, 327-334.
https://doi.org/10.7659/j.issn.1005-6947.2019.03.012

[12]   Tan, C.Q., Peng, L.B., Zeng, X.H., Li, J.H., Wan, X.M., Chen, G.N., Wang, S.Y., Ouyang, L.H. and Zhao, Z.Y. (2014) Cost–Utility Analysis of the Newly Recommended Adjuvant Chemotherapy for Resectable Gastric Cancer Patients in the 2011 Chinese National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology: Gastric Cancer. Pharmacoeconomics, 32, 235-243.
https://doi.org/10.1007/s40273-013-0065-2

[13]   Liu, G.Q. and Kang, S. (2021) Cost-Utility Analysis of Atezolizumab Combined with Standard Chemotherapy Regimen in the First-Line Treatment of Extensive-Stage Small-Cell Lung Cancer. China Pharmacy, 32, 77-81.

[14]   Shiroiwa, T., Fukuda, T. and Shimozuma, K. (2011) Cost-Effectiveness Analysis of Trastuzumab to Treat HER2-Positive Advanced Gastric Cancer Based on the Randomised ToGA Trial. British Journal of Cancer, 105, 1273-1278.
https://doi.org/10.1038/bjc.2011.390

[15]   Shao, R.J., Tang, W.X. and Ma, A.X. (2019) The Partitioned Survival Model Applied in Pharmacoeconomic Evaluation. Chinese Health Economics, 38, 60-63.

 
 
Top