Benjamin David J, Padula William V, Hsu Robert C
Hoag Family Cancer Institute, Newport Beach, CA, USA.
Department of Pharmaceutical and Health Economics, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA, USA.
Gynecol Oncol Rep. 2024 Mar 1;52:101351. doi: 10.1016/j.gore.2024.101351. eCollection 2024 Apr.
Over the past five years (2019-2023), several new targeted therapies and immunotherapy has been approved in treating relapsed cervical, ovarian, and endometrial cancers. Concurrently, there has been growing recognition of financial toxicity associated with cancer care during this time period. As such, we reviewed FDA approvals from 2019 to 2013 and identified the following approvals in gynecologic oncology: pembrolizumab plus lenvatinib, pembrolizumab for recurrent endometrial cancer that is MSI-H/dMMR, tisotumab vedotin, dostarlimab as single-agent therapy, and dostarlimab plus chemotherapy. We focused on approvals for endometrial cancer, and conducted a cost-effectiveness analysis for combination options approved in treating recurrent or advanced endometrial cancer (i.e. pembrolizumab plus lenvatinib versus placebo; dostarlimab plus chemotherapy versus placebo), and found neither regimen was cost-effective at a willingness-to-pay of $100,000 per Equal Value of Life Years Gained (evLYG). While these costs may not necessarily be translated to an individual patient, these costs are absorbed by healthcare systems and insurance providers on a larger scale with downstream effects on individuals contributing to healthcare costs a whole.
在过去五年（2019 - 2023年）中，几种新的靶向治疗和免疫疗法已被批准用于治疗复发性宫颈癌、卵巢癌和子宫内膜癌。与此同时，在此期间，人们越来越认识到癌症治疗相关的经济毒性。因此，我们回顾了2019年至2023年美国食品药品监督管理局（FDA）的批准情况，并确定了妇科肿瘤学中的以下批准：帕博利珠单抗联合乐伐替尼、用于微卫星高度不稳定/错配修复缺陷（MSI-H/dMMR）复发性子宫内膜癌的帕博利珠单抗、替索单抗维托辛、作为单药疗法的多斯塔利单抗，以及多斯塔利单抗联合化疗。我们重点关注了子宫内膜癌的批准情况，并对批准用于治疗复发性或晚期子宫内膜癌的联合方案（即帕博利珠单抗联合乐伐替尼与安慰剂对比；多斯塔利单抗联合化疗与安慰剂对比）进行了成本效益分析，发现在每获得一个质量调整生命年（evLYG）支付意愿为10万美元的情况下，这两种方案都不具有成本效益。虽然这些成本不一定会转化为个体患者的费用，但这些成本在更大规模上由医疗系统和保险提供商承担，对整个医疗费用的个体产生下游影响。
