Cost-effectiveness analysis of gemcitabine plus cisplatin versus fluorouracil plus cisplatin in the first-line setting for Chinese patients with metastatic nasopharyngeal carcinoma

  • Chaohui Jin
  • Hanrui Zheng
  • Mei Zhan
  • Feng Wen
  • Ting XuEmail author
Head and Neck



A randomized phase III trial demonstrated that gemcitabine plus cisplatin (GP) prolonged progression-free survival and overall survival compared with fluorouracil plus cisplatin (FP) as first-line chemotherapy in patients with metastatic nasopharyngeal carcinoma (NPC). The cost-effectiveness analysis was designed to identify the economic option for metastatic NPC from a Chinese societal perspective.


We established a Markov model that involved three health states representing the stages of disease to simulate therapy. Survival data of clinical outcomes were derived from the trial and adjusted to quality-adjusted life years (QALYs). Transition probabilities and health utilities were obtained from the clinical trial and published literatures. The cost-effective strategy was estimated for these treatments using a willing-to-pay (WTP) threshold. A one-way sensitivity analysis was conducted to study the influences of parameters.


GP treatment group produced a gain of 0.37 QALYs with an incremental cost of $2520.80, yielding an incremental cost-effectiveness ratio (ICER) of $6812.97 per QALY, compared with FP treatment ($15,530.96 versus $13,010.16). The ICER was lower than the accepted WTP threshold, which was 3 times gross domestic product per capita of China ($25,749 per QALY).


GP regimen is more cost-effective compared with FP regimen as the first-line treatment for Chinese patients with metastatic NPC.


Cost-effectiveness Gemcitabine Fluorouracil Cisplatin Metastatic nasopharyngeal carcinoma 



This work was supported by National Natural Science Foundation of China (No. 81572988) and Science and Technology Department of Sichuan Province Funding Project (Nos. 2016FZ0108 and 2018SZ0117).

Compliance with ethical standards

Conflict of interest

The authors declared no conflicts of interest in this work.

Ethics approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Chua MLK, Wee JTS, Hui EP, Chan ATC (2016) Nasopharyngeal carcinoma. Lancet 387(10022):1012–1024. CrossRefPubMedGoogle Scholar
  2. 2.
    Fu ZT, Guo XL, Zhang SW, Zeng HM, Sun KX, Chen WQ, He J (2018) Incidence and mortality of nasopharyngeal carcinoma in China, 2014. Zhonghua Zhong Liu Za Zhi 40(8):566–571. CrossRefPubMedGoogle Scholar
  3. 3.
    Wei KR, Zheng RS, Zhang SW, Liang ZH, Li ZM, Chen WQ (2017) Nasopharyngeal carcinoma incidence and mortality in China, 2013. Chin J Cancer 36(1):90. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Sun X, Su S, Chen C, Han F, Zhao C, Xiao W, Deng X, Huang S, Lin C, Lu T (2014) Long-term outcomes of intensity-modulated radiotherapy for 868 patients with nasopharyngeal carcinoma: an analysis of survival and treatment toxicities. Radiother Oncol 110(3):398–403. CrossRefPubMedGoogle Scholar
  5. 5.
    Tian YM, Huang WZ, Yuan X, Bai L, Zhao C, Han F (2017) The challenge in treating locally recurrent T3–4 nasopharyngeal carcinoma: the survival benefit and severe late toxicities of re-irradiation with intensity-modulated radiotherapy. Oncotarget 8(26):43450–43457. CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lee AW, Ma BB, Ng WT, Chan AT (2015) Management of nasopharyngeal carcinoma: current practice and future perspective. J Clin Oncol 33(29):3356–3364. CrossRefPubMedGoogle Scholar
  7. 7.
    Tan WL, Tan EH, Lim DW, Ng QS, Tan DS, Jain A, Ang MK (2016) Advances in systemic treatment for nasopharyngeal carcinoma. Chin Clin Oncol 5(2):21. CrossRefPubMedGoogle Scholar
  8. 8.
    Jin Y, Shi YX, Cai XY, Xia XY, Cai YC, Cao Y, Zhang WD, Hu WH, Jiang WQ (2012) Comparison of five cisplatin-based regimens frequently used as the first-line protocols in metastatic nasopharyngeal carcinoma. J Cancer Res Clin Oncol 138(10):1717–1725. CrossRefPubMedGoogle Scholar
  9. 9.
    He XY, Hu CS, Ying HM, Wu YR, Zhu GP, Liu TF (2010) Paclitaxel with cisplatin in concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 267(5):773–778. CrossRefPubMedGoogle Scholar
  10. 10.
    Ma BB, Tannock IF, Pond GR, Edmonds MR, Siu LL (2002) Chemotherapy with gemcitabine-containing regimens for locally recurrent or metastatic nasopharyngeal carcinoma. Cancer 95(12):2516–2523. CrossRefPubMedGoogle Scholar
  11. 11.
    Schwarz LR (1996) Elimination of dose limiting toxicities of cisplatin, 5-fluorouracil, and leucovorin using a weekly 24-hour infusion schedule for the treatment of patients with nasopharyngeal carcinoma. Cancer 78(3):566–567.;2-W CrossRefPubMedGoogle Scholar
  12. 12.
    Zhang L, Huang Y, Hong S, Yang Y, Yu G, Jia J, Peng P, Wu X, Lin Q, Xi X, Peng J, Xu M, Chen D, Lu X, Wang R, Cao X, Chen X, Lin Z, Xiong J, Lin Q, Xie C, Li Z, Pan J, Li J, Wu S, Lian Y, Yang Q, Zhao C (2016) Gemcitabine plus cisplatin versus fluorouracil plus cisplatin in recurrent or metastatic nasopharyngeal carcinoma: a multicentre, randomised, open-label, phase 3 trial. Lancet 388(10054):1883–1892. CrossRefPubMedGoogle Scholar
  13. 13.
    National Comprehensive Cancer Network (2018) NCCN treatment guidelines in oncology: Head and Neck cancers.
  14. 14.
    Ramsey S, Willke R, Briggs A, Brown R, Buxton M, Chawla A, Cook J, Glick H, Liljas B, Petitti D, Reed S (2005) Good research practices for cost-effectiveness analysis alongside clinical trials: the ISPOR RCT-CEA Task Force report. Value Health 8(5):521–533. CrossRefPubMedGoogle Scholar
  15. 15.
    Hannouf MB, Sehgal C, Cao JQ, Mocanu JD, Winquist E, Zaric GS (2012) Cost-effectiveness of adding cetuximab to platinum-based chemotherapy for first-line treatment of recurrent or metastatic head and neck cancer. PLoS ONE 7(6):e38557. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Murray CJ, Evans DB, Acharya A, Baltussen RM (2000) Development of WHO guidelines on generalized cost-effectiveness analysis. Health Econ 9(3):235–251CrossRefGoogle Scholar
  17. 17.
    Hutubessy R, Chisholm D, Edejer TT (2003) Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc 1(1):8. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kim HI, Lim H, Moon A (2018) Sex differences in cancer: epidemiology, genetics and therapy. Biomol Ther (Seoul) 26(4):335–342. CrossRefGoogle Scholar
  19. 19.
    Liberato NL, Rognoni C, Rubrichi S, Quaglini S, Marchetti M, Gorlia T, Licitra L, Vermorken JB (2012) Adding docetaxel to cisplatin and fluorouracil in patients with unresectable head and neck cancer: a cost-utility analysis. Ann Oncol 23(7):1825–1832. CrossRefPubMedGoogle Scholar
  20. 20.
    Ferris RL, Blumenschein G Jr, Fayette J, Guigay J, Colevas AD, Licitra L, Harrington K, Kasper S, Vokes EE, Even C, Worden F, Saba NF, Iglesias Docampo LC, Haddad R, Rordorf T, Kiyota N, Tahara M, Monga M, Lynch M, Geese WJ, Kopit J, Shaw JW, Gillison ML (2016) Nivolumab for recurrent squamous-cell carcinoma of the head and neck. N Engl J Med 375(19):1856–1867. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Tringale KR, Carroll KT, Zakeri K, Sacco AG, Barnachea L, Murphy JD (2018) Cost-effectiveness analysis of nivolumab for treatment of platinum-resistant recurrent or metastatic squamous cell carcinoma of the head and neck. J Natl Cancer Inst 110(5):479–485. CrossRefPubMedGoogle Scholar
  22. 22.
    Ward MC, Shah C, Adelstein DJ, Geiger JL, Miller JA, Koyfman SA, Singer ME (2017) Cost-effectiveness of nivolumab for recurrent or metastatic head and neck cancer. Oral Oncol 74:49–55. CrossRefPubMedGoogle Scholar
  23. 23.
    Zargar M, McFarlane T, Chan KKW, Wong WWL (2018) Cost-effectiveness of nivolumab in recurrent metastatic head and neck squamous cell carcinoma. Oncologist 23(2):225–233. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Clinical Pharmacy, West China HospitalSichuan UniversityChengduChina
  2. 2.Department of Medical Oncology, Cancer Center, West China HospitalSichuan UniversityChengduChina
  3. 3.West China Biostatistics and Cost-Benefit Analysis CenterSichuan UniversityChengduChina

Personalised recommendations