Cost-effectiveness analysis of immune checkpoint inhibitors for first-line treatment of advanced esophageal squamous cell carcinoma based on fractional polynomial network meta-analysis

Abstract

Abstract Background Recently, immune checkpoint inhibitors (ICIs) have become increasingly crucial in the treatment of esophageal cancer. Objective We sought to assess the cost-effectiveness of ICIs in addition to chemotherapy as a first-line treatment for locally advanced, recurrent, or metastatic esophageal squamous cell carcinoma (ESCC). Methods A network meta-analysis utilizing a fractional polynomial model based on the nonproportional hazards assumption was employed to evaluate the clinical benefits of different therapeutic strategies. A partitioned survival model was established for comparing the cost-effectiveness of ICIs alone alongside chemotherapy versus chemotherapy alone as initial therapy for locally advanced, recurrent, or metastatic ESCC from the perspective of the Chinese healthcare system. The model extended the time horizon to 10 years with a 1-month cycle, incorporating data from network meta-analysis and clinical trials for effectiveness and safety as well as data from databases and relevant literature for cost and utility. Sensitivity analyses were carried out to evaluate the uncertainty and variability of the findings. Results Basic analysis revealed that the incremental cost-effectiveness ratios (ICERs) for camrelizumab, sintilimab, tislelizumab and toripalimab plus chemotherapy versus chemotherapy alone were $24,853.78, $21,771.95, $25,973.70, and $22,694.01/QALY, respectively, all of which were less than 3 times the per capita GDP in China. Sensitivity analysis indicated that the base-case results were robust. Conclusions In the Chinese healthcare system, the combination of sintilimab or toripalimab with chemotherapy represents the most cost-effective treatment strategy.