AUTHOR=Ye Zhuo-Miao , Xu Zhe , Zeng Fan-Yuan , Tang Zi-Qing , Zhou Qin 

TITLE=Cost-Effectiveness Analysis of Sintilimab Combined with Chemotherapy Versus Chemotherapy Alone as the First-Line Treatment for Advanced Esophageal Cancer

JOURNAL=Frontiers in Pharmacology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.934275

DOI=10.3389/fphar.2022.934275

ISSN=1663-9812

ABSTRACT=Objective: A poor prognosis is associated with oesophageal cancer, ranking sixth in global cancer mortality rates. In comparison with chemotherapy, the ORIENT-15 trial showed sintilimab plus chemotherapy significantly improved survival. We evaluated the cost-effectiveness of sintilimab plus chemotherapy in treating patients with esophageal cancer in this study.
Perspective: the Chinese payers.
Methods: A Markov model with a 10-year horizon was developed on the basis of the Chinese healthcare payers’ perspectives. We conducted a cost-effectiveness analysis for PD-L1 combined positive score of 10 or more(CPS≥10 groups) and all randomised patients groups(any PD-L1 expression group). We estimated the costs, summarised their effectiveness as quality-adjusted life-years (QALYs) and computed Incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were conducted to explore the impact of uncertainties on the cost-effectiveness’s results. 
Results: In the base-case analysis, the incremental cost-effectiveness ratios (ICER) for sintilimab plus chemotherapy versus chemotherapy was $21024.05 in any PD-L1 expression group and $20974.23 in PD-L1 combined positive score of 10 or more group. This exceeded the threshold of willingness to pay ($37653). One-way sensitivity analysis demonstrated that the ICERs were the most sensitive to the price of sintilimab. 
Conclusions: Evidence suggests that first-line sintilimab plus chemotherapy therapy for advanced oesophageal cancer may not be cost-effective compared with chemotherapy in the chinese, regardless of the PD-L1 expression.