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Tislelizumab Plus Chemotherapy Versus Placebo Plus Chemotherapy as First-Line Treatment for Chinese Patients with Advanced Esophageal Squamous Cell Carcinoma: A Cost-Effectiveness Analysis

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Abstract

Background and Objectives

Advanced esophageal squamous cell carcinoma (ESCC) is a prevalent and highly malignant tumor with a poor prognosis. Recently, the RATIONALE-306 trial demonstrated that tislelizumab combined with chemotherapy provided overall survival benefits for these patients. This study aimed to assess the cost-effectiveness of this treatment approach in Chinese patients with advanced ESCC from the perspective of healthcare system.

Methods

A Markov model was constructed to assess the economic and health benefits associated with tislelizumab plus chemotherapy over a 10-year lifetime horizon, utilizing data from the RATIONALE-306 trial. The analysis encompassed the calculation of several key parameters, including the incremental cost-effectiveness ratio (ICER), total cost, incremental cost, total effectiveness, and incremental effectiveness. Tislelizumab was considered cost-effective if the ICER obtained was below the willingness-to-pay (WTP) threshold of US$38,223 per quality-adjusted life-year (QALY); otherwise, it would be deemed not cost-effective. To ensure the robustness of the findings, the results were subjected to one-way sensitivity analysis and probabilistic sensitivity analysis (PSA).

Results

In the base-case analysis, the incremental effectiveness and cost associated with tislelizumab plus chemotherapy, compared to chemotherapy alone, were determined to be 0.40 QALY and US$7604, respectively. This resulted in an ICER of US$18,846 per QALY, which is below the WTP threshold of US$38,223 per QALY. Furthermore, the results from the one-way sensitivity analysis and PSA indicated robustness of the findings.

Conclusion

Our lifetime simulation study demonstrated that, in the case of advanced ESCC, the combination of tislelizumab and chemotherapy offers increased effectiveness compared to chemotherapy alone, albeit at a higher cost. Moreover, considering the current WTP threshold in China, the addition of tislelizumab to chemotherapy is considered a cost-effective approach.

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Author information

Author notes

  1. Shijie Lu and Yake Lou contributed equally to this work and share first authorship.

Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China

    Shijie Lu, Yi Rong, Zirui Huang, Xiaodan Lin, Junying Chen & Kongjia Luo

  2. Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Chongqing, 400010, China

    Yake Lou

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  1. Shijie Lu
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Correspondence to Kongjia Luo.

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Funding

This study was funded by the National Natural Science Foundation of China (82002469).

Conflict of interest

The authors declare no conflicts of interest in this study.

Availability of data and materials

The study includes the original contributions, which can be found in the article/online supplementary material. For further inquiries, please contact the corresponding author.

Ethics approval

Not applicable.

Author contributions

JC and KL conceived and designed the protocol, while SL and YL synthesized the data and drafted the manuscript. YR, XL, and ZH participated in data collection and analysis. All authors approved the final version of the manuscript.

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Code availability

All the software used in the study has been documented in the article. The R code used in the analysis can be accessed by contacting the corresponding author through reasonable request.

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Lu, S., Lou, Y., Rong, Y. et al. Tislelizumab Plus Chemotherapy Versus Placebo Plus Chemotherapy as First-Line Treatment for Chinese Patients with Advanced Esophageal Squamous Cell Carcinoma: A Cost-Effectiveness Analysis. Clin Drug Investig 43, 643–652 (2023). https://doi.org/10.1007/s40261-023-01295-2

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