AccScience Publishing / EJMO / Online First / DOI: 10.36922/ejmo.7075
Submit to EJMO
Cite this article
10
Download
228
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
ORIGINAL RESEARCH ARTICLE

Cost-effectiveness of nivolumab plus chemotherapy for advanced gastric/gastroesophageal junction/esophageal adenocarcinoma in the United States

Jin Zhou1 ,  Wei Oy-Yang2 ,  Xia Yin3 ,  Han Zhan3 ,  Jin Luo3 ,  Ge-Li Li4*
Show Less
1 Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
2 Department of Project Management, Hunan Institute of Microbiology, Hunan Academy of Agricultural Sciences, Changsha, Hunan, China
3 Department of Oncology, 921 Hospital of Joint Logistic Support Force, The Chinese People’s Liberation Army, Changsha, Hunan, China
4 Department of Oncology, Affiliated Hospital of Xiangnan University, Chenzhou, Hunan, China
EJMO, 7075 https://doi.org/10.36922/ejmo.7075
Submitted: 5 December 2024 | Revised: 2 January 2025 | Accepted: 14 January 2025 | Published: 4 February 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Download PDF
Cite
XML
Abstract

Nivolumab, in combination with chemotherapy, significantly improves survival in patients with gastric/gastroesophageal junction (G/GEJ)/esophageal adenocarcinoma. The study evaluated the cost-effectiveness of nivolumab plus chemotherapy for the treatment of G/GEJ/esophageal adenocarcinoma. A Markov model was developed from the perspective of United States healthcare payers. We estimated costs and summarized effectiveness in terms of quality-adjusted life-years (QALYs). One-way and probabilistic sensitivity analyses were conducted to assess the impact of uncertainties on the cost-effectiveness results. The incremental cost-effectiveness ratio for nivolumab plus chemotherapy ($149,636.97, 1.24 QALYs) compared to chemotherapy alone ($13,941.06, 0.75 QALYs) is $135,695.91, with a difference of 0.49 QALYs. Evidence suggests that nivolumab plus chemotherapy for the first-line treatment of locally advanced or metastatic G/GEJ/esophageal adenocarcinoma may not represent a cost-effective option within the United States healthcare system.

Keywords
Cost-effectiveness
Nivolumab
Metastatic gastric/gastroesophageal junction/esophageal adenocarcinoma
Markov model
Funding
The study was self-funded by the authors and did not rely on external funding sources.
Conflict of interest
The authors declare that there is no conflict of interest.
References
  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi: 10.3322/caac.21492

 

  1. Ajani JA, D’Amico TA, Almhanna K, et al. Gastric cancer, version 3.2016, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2016;14(10):1286-1312. doi: 10.6004/jnccn.2016.0137

 

  1. Gunderson LL. Gastric cancer--patterns of relapse after surgical resection. Semin Radiat Oncol. 2002;12(2):150-161. doi: 10.1053/srao.2002.30817

 

  1. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021;24(1):1-21. doi: 10.1007/s10120-020-01042-y

 

  1. Smyth EC, Verheij M, Allum W, et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(Suppl 5):V38-V49. doi: 10.1093/annonc/mdw350

 

  1. Wang FH, Shen L, Li J, et al. The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer. Cancer Commun Lond Engl. 2019;39(1):10. doi: 10.1186/s40880-019-0349-9

 

  1. Catenacci DVT, Tebbutt NC, Davidenko I, et al. Rilotumumab plus epirubicin, cisplatin, and capecitabine as first-line therapy in advanced MET-positive gastric or gastro-oesophageal junction cancer (RILOMET-1): A randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2017;18(11):1467-1482.doi: 10.1016/S1470-2045(17)30566-1

 

  1. Fuchs CS, Shitara K, Di Bartolomeo M, et al. Ramucirumab with cisplatin and fluoropyrimidine as first-line therapy in patients with metastatic gastric or junctional adenocarcinoma (RAINFALL): A double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol. 2019;20(3):420-435. doi: 10.1016/S1470-2045(18)30791-5

 

  1. Lordick F, Kang YK, Chung HC, et al. Capecitabine and cisplatin with or without cetuximab for patients with previously untreated advanced gastric cancer (EXPAND): A randomised, open-label phase 3 trial. Lancet Oncol. 2013;14(6):490-499. doi: 10.1016/S1470-2045(13)70102-5

 

  1. Shah MA, Bang YJ, Lordick F, et al. Effect of fluorouracil, leucovorin, and oxaliplatin with or without onartuzumab in HER2-negative, MET-positive gastroesophageal adenocarcinoma: The METGastric randomized clinical trial. JAMA Oncol. 2017;3(5):620-627. doi: 10.1001/jamaoncol.2016.5580

 

  1. Ando K, Kishino Y, Homma T, et al. Nivolumab plus ipilimumab versus existing immunotherapies in patients with PD-L1-positive advanced non-small cell lung cancer: A systematic review and network meta-analysis. Cancers. 2020;12(7):1905. doi: 10.3390/cancers12071905

 

  1. Edwards SJ, Wakefield V, Cain P, et al. Axitinib, cabozantinib, everolimus, nivolumab, sunitinib and best supportive care in previously treated renal cell carcinoma: A systematic review and economic evaluation. Health Technol Assess Winch Engl. 2018;22(6):1-278. doi: 10.3310/hta22060

 

  1. Janjigian YY, Shitara K, Moehler M, et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): A randomised, open-label, phase 3 trial. Lancet Lond Engl. 2021;398(10294):27-40. doi: 10.1016/S0140-6736(21)00797-2

 

  1. Verma V, Sprave T, Haque W, et al. A systematic review of the cost and cost-effectiveness studies of immune checkpoint inhibitors. J Immunother Cancer. 2018;6(1):128. doi: 10.1186/s40425-018-0442-7

 

  1. Bullement A, Latimer NR, Bell Gorrod H. Survival extrapolation in cancer immunotherapy: A validation-based case study. Value Health J Int Soc Pharmacoeconomics Outcomes Res. 2019;22(3):276-283. doi: 10.1016/j.jval.2018.10.007

 

  1. Othus M, Bansal A, Koepl L, Wagner S, Ramsey S. Accounting for cured patients in cost-effectiveness analysis. Value Health J Int Soc Pharmacoeconomics Outcomes Res. 2017;20(4):705-709. doi: 10.1016/j.jval.2016.04.011

 

  1. Yang P. Epidemiology of lung cancer prognosis: Quantity and quality of life. Methods Mol Biol Clifton NJ. 2009;471:469-486. doi: 10.1007/978-1-59745-416-2_24

 

  1. Huang M, Lou Y, Pellissier J, et al. Cost effectiveness of pembrolizumab vs. standard-of-care chemotherapy as first-line treatment for metastatic NSCLC that expresses high levels of PD-L1 in the United States. Pharmacoeconomics. 2017;35(8):831-844. doi: 10.1007/s40273-017-0527-z

 

  1. Lin S, Luo S, Zhong L, et al. Cost-effectiveness of atezolizumab plus chemotherapy for advanced non-small-cell lung cancer. Int J Clin Pharm. 2020;42(4):1175-1183. doi: 10.1007/s11096-020-01076-3

 

  1. Sanders GD, Neumann PJ, Basu A, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: Second panel on cost-effectiveness in health and medicine. JAMA. 2016;316(10):1093-1103. doi: 10.1001/jama.2016.12195

 

  1. Thokala P, Ochalek J, Leech AA, Tong T. Cost-effectiveness thresholds: The past, the present and the future. Pharmacoeconomics. 2018;36(5):509-522. doi: 10.1007/s40273-017-0606-1

 

  1. Guyot P, Ades AE, Ouwens MJNM, Welton NJ. Enhanced secondary analysis of survival data: Reconstructing the data from published Kaplan-Meier survival curves. BMC Med Res Methodol. 2012;12:9. doi: 10.1186/1471-2288-12-9

 

  1. Liu M, Zhang L, Huang Q, Li N, Zheng B, Cai H. Cost-effectiveness analysis of ceritinib and alectinib versus crizotinib in the treatment of anaplastic lymphoma kinase-positive advanced non-small cell lung cancer. Cancer Manag Res. 2019;11:9195-9202. doi: 10.2147/CMAR.S223441

 

  1. Wang X, Jin L, Cui J, Ma K, Chen X, Li W. Mouse double minute-2 homolog (MDM2)-rs2279744 polymorphism associated with lung cancer risk in a Northeastern Chinese population. Thorac Cancer. 2015;6(1):91-96. doi: 10.1111/1759-7714.12153

 

  1. Zhang L, Zeng X, Cai H, et al. Cost-effectiveness of second-line nivolumab for platinum-treated advanced non-small-cell lung cancer. J Comp Eff Res. 2020;9(18):1301-1309. doi: 10.2217/cer-2020-0053

 

  1. Chen HD, Zhou J, Wen F, et al. Cost-effectiveness analysis of apatinib treatment for chemotherapy-refractory advanced gastric cancer. J Cancer Res Clin Oncol. 2017;143(2):361-368.doi: 10.1007/s00432-016-2296-z

 

  1. Wang SJ, Fuller CD, Choi M, Thomas CR. A cost-effectiveness analysis of adjuvant chemoradiotherapy for resected gastric cancer. Gastrointest Cancer Res GCR. 2008;2(2):57-63.

 

  1. Yeh JM, Hur C, Kuntz KM, Ezzati M, Goldie SJ. Cost-effectiveness of treatment and endoscopic surveillance of precancerous lesions to prevent gastric cancer. Cancer. 2010;116(12):2941-2953. doi: 10.1002/cncr.25030

 

  1. Wan N, Zhang TT, Hua SH, et al. Cost-effectiveness analysis of pembrolizumab plus chemotherapy with PD-L1 test for the first-line treatment of NSCLC. Cancer Med. 2020;9(5):1683-1693. doi: 10.1002/cam4.2793

 

  1. Zhang PF, Xie D, Li Q. Cost-effectiveness analysis of nivolumab in the second-line treatment for advanced esophageal squamous cell carcinoma. Future Oncol Lond Engl. 2020;16(17):1189-1198. doi: 10.2217/fon-2019-0821

 

  1. Chouaid C, Bensimon L, Clay E, et al. Cost-effectiveness analysis of pembrolizumab versus standard-of-care chemotherapy for first-line treatment of PD-L1 positive (>50%) metastatic squamous and non-squamous non-small cell lung cancer in France. Lung Cancer Amst Neth. 2019;127:44-52. doi: 10.1016/j.lungcan.2018.11.008

 

  1. Ding D, Hu H, Liao M, et al. Cost-effectiveness analysis of atezolizumab plus chemotherapy in the first-line treatment of metastatic non-squamous non-small cell lung cancer. Adv Ther. 2020;37(5):2116-2126. doi: 10.1007/s12325-020-01292-3

 

  1. Pongchaiyakul C, Nanagara R, Songpatanasilp T, Unnanuntana A. Cost-effectiveness of denosumab for high-risk postmenopausal women with osteoporosis in Thailand. J Med Econ. 2020;23(7):776-785. doi: 10.1080/13696998.2020.1730381

 

  1. Nafees B, Stafford M, Gavriel S, Bhalla S, Watkins J. Health state utilities for non small cell lung cancer. Health Qual Life Outcomes. 2008;6:84. doi: 10.1186/1477-7525-6-84

 

  1. Ward MC, Shah C, Adelstein DJ, et al. Cost-effectiveness of nivolumab for recurrent or metastatic head and neck cancer. Oral Oncol. 2017;74:49-55. doi: 10.1016/j.oraloncology.2017.09.017

 

  1. Lam SW, Wai M, Lau JE, McNamara M, Earl M, Udeh B. Cost-effectiveness analysis of second-line chemotherapy agents for advanced gastric cancer. Pharmacotherapy. 2017;37(1):94-103. doi: 10.1002/phar.1870
Share
Back to top
Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept