Huo Gengwei, Song Ying, Liu Wei, Guo Hua, Chen Peng
Department of Thoracic Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
National Clinical Research Center for Cancer, Tianjin, China.
Front Pharmacol. 2024 Jun 20;15:1391896. doi: 10.3389/fphar.2024.1391896. eCollection 2024.
In the double-blind, phase III, placebo-controlled RUBY randomized clinical trial, dostarlimab plus carboplatin-paclitaxel significantly increased survival among patients with primary advanced or recurrent endometrial cancer (EC). We conducted a cost-effectiveness analysis of dostarlimab in combination with chemotherapy in these patients stratified by mismatch repair-deficient (dMMR) and mismatch repair-proficient (pMMR) subgroups from the perspective of a United States payer.
A Markov model with three states was employed to simulate patients who were administered either dostarlimab in combination with chemotherapy or chemotherapy based on the RUBY trial. Quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratio (ICER) were calculated with a willingness-to-pay (WTP) threshold of $150,000 per QALY. Both univariate and probabilistic sensitivity analyses were carried out to explore the robustness of the model.
In dMMR EC, the combination of dostarlimab and chemotherapy achieved an additional 5.48 QALYs at an incremental cost of $330,747 compared to chemotherapy alone, resulting in an ICER of $60,349.30 per QALY. In pMMR EC, there were 1.51 additional QALYs gained at an extra cost of $265,148, yielding an ICER of $175,788.47 per QALY. With a 15.2% discount on dostarlimab, the ICER decreased to $150,000 per QALY in the pMMR EC. The univariate sensitivity analysis revealed that the cost of dostarlimab, utility of progression-free survival (PFS), and progressive disease (PD) had the most significant impacts on the outcomes. Probabilistic sensitivity analysis revealed that dostarlimab had a 100% likelihood of being considered cost-effective for patients at a WTP threshold of $150,000 per QALY for dMMR EC, whereas this likelihood was only 0.5% for pMMR EC.
Dostarlimab in combination with chemotherapy was cost-effective for primary advanced or recurrent dMMR EC from the perspective of a United States payer at a WTP threshold of $150,000 per QALY, but not for pMMR EC. Lowering the prices of dostarlimab could potentially enhance the cost-effectiveness of treatment for pMMR EC.
在双盲、III期、安慰剂对照的RUBY随机临床试验中，多斯塔利单抗联合卡铂-紫杉醇显著提高了原发性晚期或复发性子宫内膜癌（EC）患者的生存率。我们从美国医保支付方的角度，对多斯塔利单抗联合化疗在错配修复缺陷（dMMR）和错配修复 proficient（pMMR）亚组的这些患者中的成本效益进行了分析。
采用具有三个状态的马尔可夫模型，根据RUBY试验模拟接受多斯塔利单抗联合化疗或化疗的患者。计算了质量调整生命年（QALY）、终身成本和增量成本效益比（ICER），支付意愿（WTP）阈值为每QALY 150,000美元。进行了单变量和概率敏感性分析，以探索模型的稳健性。
在dMMR EC中，与单纯化疗相比，多斯塔利单抗联合化疗增加了5.48个QALY，增量成本为330,747美元，ICER为每QALY 60,349.30美元。在pMMR EC中，额外获得了1.51个QALY，额外成本为265,148美元，ICER为每QALY 175,788.47美元。多斯塔利单抗价格降低15.2%后，pMMR EC的ICER降至每QALY 150,000美元。单变量敏感性分析显示，多斯塔利单抗的成本、无进展生存期（PFS）的效用和疾病进展（PD）对结果影响最为显著。概率敏感性分析显示，对于dMMR EC患者，在每QALY支付意愿阈值为150,000美元时，多斯塔利单抗被认为具有成本效益的可能性为100%，而对于pMMR EC患者，这一可能性仅为0.5%。
从美国医保支付方的角度来看，在每QALY支付意愿阈值为150,000美元时，多斯塔利单抗联合化疗对原发性晚期或复发性dMMR EC具有成本效益，但对pMMR EC则不然。降低多斯塔利单抗的价格可能会提高pMMR EC治疗的成本效益。
