Columbia University College of Physicians and Surgeons, New York, New York, USA.
New York Presbyterian Hospital, New York, New York, USA.
BJOG. 2023 Jan;130(2):214-221. doi: 10.1111/1471-0528.17338. Epub 2022 Nov 21.
Patients with recurrent endometrial cancer treated with carboplatin and paclitaxel whose disease progresses have few effective treatment options. Based on promising clinical trial data, the anti-programmed cell death 1 (anti-PD-1) antibody dostarlimab was recently granted accelerated approval for endometrial cancer by the US Food and Drug Administration. We developed a decision model to examine the cost-effectiveness of dostarlimab for patients with progressive/recurrent deficient mismatch repair (dMMR) endometrial cancer whose disease has progressed with first-line chemotherapy.
Cost-effectiveness study.
Hypothetical cohort of 6000 women with progressive/recurrent dMMR endometrial cancer.
The initial decision point in the Markov model was treatment with dostarlimab, pembrolizumab or pegylated liposomal doxorubicin (PLD). Model probabilities, and cost and utility values were derived with assumptions drawn from published literature. Effectiveness was estimated as average quality-adjusted life years (QALYs) gained. One-way, two-way and probabilistic sensitivity analyses were performed to vary the assumptions across a range of plausible values.
The primary outcome was the incremental cost-effectiveness ratio (ICER).
Pegylated liposomal doxorubicin (PLD) was the least costly strategy, at $55,732, followed by dostarlimab ($151,533) and pembrolizumab ($154,597). Based on a willingness-to-pay threshold of $100,000/QALY, PLD was cost-effective compared with dostarlimab, with an ICER of $331,913 per QALY gained for dostarlimab, whereas pembrolizumab was ruled out by extended dominance (less effective, more costly), compared with dostarlimab. In one-way sensitivity analyses, dostarlimab was cost-effective when its cost was reduced to $4905 (52% reduction). These results were robust in a variety of sensitivity analyses.
Dostarlimab is associated with greater survival compared with other treatments for women with recurrent dMMR endometrial cancer. Although the agent is substantially more costly, dostarlimab became cost-effective when its cost was reduced to $5489 per cycle.
接受卡铂和紫杉醇治疗后疾病进展的复发性子宫内膜癌患者，其治疗选择有限。基于有前景的临床试验数据，抗程序性细胞死亡蛋白 1（抗 PD-1）抗体 dostarlimab 最近被美国食品和药物管理局加速批准用于子宫内膜癌。我们开发了一个决策模型，以检查 dostarlimab 用于一线化疗后疾病进展的复发性/转移性缺陷错配修复（dMMR）子宫内膜癌患者的成本效益。
成本效益研究。
6000 名患有进展性/复发性 dMMR 子宫内膜癌的假设队列。
Markov 模型的初始决策点是接受 dostarlimab、pembrolizumab 或聚乙二醇化脂质体多柔比星（PLD）治疗。模型概率以及成本和效用值是根据已发表文献中的假设得出的。有效性估计为平均质量调整生命年（QALY）的增加。进行了单因素、双因素和概率敏感性分析，以在一系列合理的假设值范围内改变假设。
主要结果是增量成本效益比（ICER）。
聚乙二醇化脂质体多柔比星（PLD）是最具成本效益的策略，为 55732 美元，其次是 dostarlimab（151533 美元）和 pembrolizumab（154597 美元）。基于 100000 美元/QALY 的支付意愿阈值，与 dostarlimab 相比，PLD 具有成本效益，dostarlimab 每获得一个 QALY 的增量成本效益比为 331913 美元，而 pembrolizumab 与 dostarlimab 相比被扩展优势（效果较差，成本较高）排除在外。在单因素敏感性分析中，当 dostarlimab 的成本降低到 4905 美元（降低 52%）时，它具有成本效益。这些结果在各种敏感性分析中是稳健的。
与其他治疗方法相比，dostarlimab 可使复发性 dMMR 子宫内膜癌女性的生存率提高。尽管该药物的成本要高得多，但当 dostarlimab 的成本降低到每个周期 5489 美元时，它就具有成本效益。
