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

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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusion

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

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Funding

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).

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Authors and Affiliations

  1. Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, China

    Chaohui Jin, Hanrui Zheng, Mei Zhan & Ting Xu

  2. Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China

    Feng Wen

  3. West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China

    Feng Wen

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  1. Chaohui Jin
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  2. Hanrui Zheng
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  4. Feng Wen
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Correspondence to Ting Xu.

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Jin, C., Zheng, H., Zhan, M. et al. Cost-effectiveness analysis of gemcitabine plus cisplatin versus fluorouracil plus cisplatin in the first-line setting for Chinese patients with metastatic nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 277, 577–584 (2020). https://doi.org/10.1007/s00405-019-05714-z

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