Cost-effectiveness analysis of the combination of low-dose nivolumab with triple metronomic chemotherapy for advanced head and neck squamous cell carcinoma in China | Health Decision

Cost-effectiveness analysis of the combination of low-dose nivolumab with triple metronomic chemotherapy for advanced head and neck squamous cell carcinoma in China

Authors

  • Yingdan Cao
  • Fenghao Shi
  • Yuantong Li
  • Xiaoxia Wei
  • Hongbin Yi
  • Sheng Han

DOI:

https://doi.org/10.54844/hd.2024.0008

Keywords:

cost-effectiveness, low-dose nivolumab, triple metronomic chemotherapy, head and neck squamous cell carcinoma

Abstract

Objective: The combination of low-dose nivolumab with triple metronomic chemotherapy (TMC-I) proposes a novel approach,

potentially enhancing patient prognosis while mitigating financial barriers. The purpose of this study was to compare the cost

effectiveness of TMC-I compared to triple metronomic chemotherapy (TMC) in the treatment of advanced head and neck

squamous cell carcinoma (HNSCC) patients in China, the largest developing country.

Methods: A partitioned survival model (PSM) was developed based on a randomized clinical trial from the perspective of Chinese

health care system. Costs and utility were derived from open-access databases and literatures. A 5% annual discount rate was

applied to both costs and outcomes. The primary outcome was incremental cost-effectiveness ratio (ICER). A willingness-to-pay

(WTP) threshold of ¥44,679/QALY based on supply-side and ¥134,037/QALY based on demand-side were set. Sensitivity

analyses including one-way sensitivity analysis, probabilistic sensitivity analysis and scenario analysis were conducted to test

the model stability; subgroup analyses were also included.

Results: TMC-I yielded an additional 0.41 quality-adjusted life years (QALYs) while increasing costs by ¥47,346.98 relative

to TMC, leading an ICER of ¥116,374.22/QALY. Sensitivity analysis showed that utility of progression-free survival (PFS) had

the greatest impact on results. In scenario analysis which the utilities calculated by the time-to-death (TTD) were adopted, the

results showed that the ICER was ¥114,795.25/QALY. In the probabilistic sensitivity analysis, the probabilities that TMC-I was

cost-effective at thresholds of ¥134,037/QALY, ¥44,679/QALY gained were 60.9%, 9.4%, respectively. Subgroup analysis

results indicated TMC-I was dominated vs. TMC for patients with no previous taxane and PD-L1 score > 50.

Conclusion: For Patients with recurrent or newly diagnosed advanced head and neck squamous cell carcinoma, TMC-I is

cost-effective at a WTP thresholds of ¥134,037/QALY and is not cost-effective when the WTP thresholds was ¥44,679/QALY

compared with TMC.

Key words: cost-effectiveness, low-dose nivolumab, triple metronomic chemotherapy, head and neck squamous cell carcinoma

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Published

2024-07-12

How to Cite

1.
Cao Y, Shi F, Li Y, Wei X, Yi H, Han S. Cost-effectiveness analysis of the combination of low-dose nivolumab with triple metronomic chemotherapy for advanced head and neck squamous cell carcinoma in China. Health Decision. 2024;2(S1). doi:10.54844/hd.2024.0008

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ABSTRACT

Cost-effectiveness analysis of the combination of low-dose nivolumab with triple metronomic chemotherapy for advanced head and neck squamous cell carcinoma in China


Yingdan Cao1#, Fenghao Shi1#, Yuantong Li1, Xiaoxia Wei2, Hongbin Yi1, Sheng Han1*

1International Research Center for Medicinal Administration, Peking University, Beijing 100871, China

2Department of Pharmacy, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou 350001, Fujian Province, China


#These authors contributed equally to this work.

*Corresponding Author:

Sheng Han, E-mail: hansheng@bjmu.edu.cn


Received: 15 June 2024 Published: 15 July 2024


ABSTRACT

Objective: The combination of low-dose nivolumab with triple metronomic chemotherapy (TMC-I) proposes a novel approach, potentially enhancing patient prognosis while mitigating financial barriers. The purpose of this study was to compare the cost-effectiveness of TMC-I compared to triple metronomic chemotherapy (TMC) in the treatment of advanced head and neck squamous cell carcinoma (HNSCC) patients in China, the largest developing country.

Methods: A partitioned survival model (PSM) was developed based on a randomized clinical trial from the perspective of Chinese health care system. Costs and utility were derived from open-access databases and literatures. A 5% annual discount rate was applied to both costs and outcomes. The primary outcome was incremental cost-effectiveness ratio (ICER). A willingness-to-pay (WTP) threshold of ¥44,679/QALY based on supply-side and ¥134,037/QALY based on demand-side were set. Sensitivity analyses including one-way sensitivity analysis, probabilistic sensitivity analysis and scenario analysis were conducted to test the model stability; subgroup analyses were also included.

Results: TMC-I yielded an additional 0.41 quality-adjusted life years (QALYs) while increasing costs by ¥47,346.98 relative to TMC, leading an ICER of ¥116,374.22/QALY. Sensitivity analysis showed that utility of progression-free survival (PFS) had the greatest impact on results. In scenario analysis which the utilities calculated by the time-to-death (TTD) were adopted, the results showed that the ICER was ¥114,795.25/QALY. In the probabilistic sensitivity analysis, the probabilities that TMC-I was cost-effective at thresholds of ¥134,037/QALY, ¥44,679/QALY gained were 60.9%, 9.4%, respectively. Subgroup analysis results indicated TMC-I was dominated vs. TMC for patients with no previous taxane and PD-L1 score >50.

Conclusion: For Patients with recurrent or newly diagnosed advanced head and neck squamous cell carcinoma, TMC-I is cost-effective at a WTP thresholds of ¥134,037/QALY and is not cost-effective when the WTP thresholds was ¥44,679/QALY compared with TMC.

Key words: cost-effectiveness, low-dose nivolumab, triple metronomic chemotherapy, head and neck squamous cell carcinoma