ORIGINAL RESEARCH article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1459695
Sugemalimab plus Chemotherapy vs Chemotherapy for Treatment of Chinese Patients with Esophageal Squamous Cell Carcinoma: A Cost Effectiveness Analysis to Inform Desicion Making
Provisionally accepted
- 1Chengdu University of Traditional Chinese Medicine, Chengdu, China
- 2Guangzhou Zhongwei Public Health Technology Assessment Institute, Guangzhou, China
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The GEMSTONE-304 trial established the clinical benefits of sugemalimab plus chemotherapy in advanced esophageal squamous-cell carcinoma (ESCC). This study evaluates the cost-effectiveness of this regimen versus chemotherapy alone as the first-line treatment for advanced ESCC patients from the perspective of China's health system.We established a partitioned survival model based on GEMSTONE-304 trial data, we simulated lifetime outcomes through three health states: progression-free survival, progressive disease, and death. Key parameters included quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER), analyzed with 5% discounting. Sensitivity analyses encompassed probabilistic, one-way, and scenario evaluations.The sugemalimab combination yielded 0.336 incremental QALYs at $ 44,182.03 additional cost (ICER = $ 131,544.70 / QALY). PD-L1 subgroup ICERs exhibited dose-dependent efficacy: $ 187,421.63 / QALY (Combined Positive Score (CPS) ＜ 1), $ 175,689.56 (1 ≤ CPS ＜ 10), and $ 130,349.21 (CPS ≥ 10). Scenario analysis demonstrated ICER reduction to $ 51,454.12 / QALY under consideraton of patient assistance program. None of the results demonstrated cost-effectiveness for this therapeutic regimen. Sensitivity analyses identified sugemalimab pricing as the dominant driver of ICER, while simultaneously validating the model's internal and external validity. Price cap simulations determined that a minimum 91.20% price reduction is required to achieve cost-effectiveness. Current pricing renders sugemalimab combination therapy economically unfavorable as first-line ESCC treatment in China. Strategic price adjustments could enhance cost-effectiveness potential.
Keywords: Cost-Effectiveness, sugemalimab, esophageal squamous cell carcinoma, partitioned survival model, PD-L1 cost-effectiveness, PD-L1
Received: 04 Jul 2024; Accepted: 23 May 2025.
Copyright: © 2025 Chen, Sun and Li. 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:
Qiuping Chen, Chengdu University of Traditional Chinese Medicine, Chengdu, China
Baixue Li, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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