SYSTEMATIC REVIEW article
Front. Health Serv.
Sec. Cost and Resource Allocation
Volume 5 - 2025 | doi: 10.3389/frhs.2025.1616223
This article is part of the Research TopicStreamlining Drug Approvals: Addressing Policy Challenges in Genitourinary OncologyView all 4 articles
Cost-Effectiveness of Chemotherapy for Advanced and Recurrent Cervical Cancer: A Systematic Review
Provisionally accepted
- Department of Obstetrics and Gynecology, Fujinomiya City General Hospital, Fujinomiya, Japan
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Advanced and recurrent cervical cancer often requires palliative chemotherapy and is associated with poor prognosis. Recently, various systemic therapies-including cytotoxic drugs, anti-angiogenic agents, and immune checkpoint inhibitors-have been evaluated for their cost-effectiveness in this setting. We conducted a systematic review of English language-based research publications reporting incremental cost-effectiveness ratios (ICERs) for chemotherapy-based treatments in advanced or recurrent cervical cancer.Literature was retrieved from PubMed, Scopus, and Web of Science, without date restrictions, and screened based on predefined eligibility criteria. A total of 10 studies were included, reporting ICERs from different healthcare systems, including the United States, United Kingdom, and China.Traditional first-line platinum-based doublet chemotherapy (e.g., cisplatin plus paclitaxel) was consistently found to be cost-effective, with ICERs well below common willingness-topay (WTP) thresholds. The addition of bevacizumab improved survival but substantially increased costs, yielding borderline or unfavorable ICERs ($155,000/QALY in the U.S.).Immunotherapy (e.g., pembrolizumab, cadonilimab) demonstrated clinical benefits but frequently exceeded WTP thresholds, particularly in low-and middle-income settings.Cemiplimab, as second-line treatment, had an ICER ($111,000/QALY) that approached the upper limit of cost-effectiveness in the U.S., while newer agents like tisotumab vedotin were found to be economically unviable under current pricing.Cost-effectiveness varied significantly across regions, influenced by drug prices, healthcare system perspectives, and local WTP thresholds. While newer agents offer incremental survival benefits, their high costs often outweigh the gains in quality-adjusted life years (QALYs). Policymakers and clinicians must consider the economic impact of adopting such treatments and prioritize strategies to improve value-such as drug price reductions, biosimilar adoption, and patient selection based on biomarkers. Future research should support evidence-based pricing and access models that enable sustainable cancer care globally.
Keywords: cervical cancer, Cost-Effectiveness, chemotherapy, Immunotherapy, qualityadjusted life year, ICER, Advanced cervical cancer, Recurrent cervical cancer
Received: 22 Apr 2025; Accepted: 15 Jul 2025.
Copyright: © 2025 Inami. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Katsuaki Inami, Department of Obstetrics and Gynecology, Fujinomiya City General Hospital, Fujinomiya, Japan
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