Cost-effectiveness analysis of sintilimab additional to chemoradiotherapy in highrisk locoregionally advanced nasopharyngeal carcinoma

Longjiang She¹Siqi Tang¹Jiaqi Han²Guichao Liu¹Lusi Chen¹Yang Zhang¹Weijun Luo¹Weihan Zuo¹Feng Ma¹Yan Xiong¹Ning Zhang^1*

• ¹Cancer Center, First People’s Hospital of Foshan, Foshan, China
• ²West China Hospital, Sichuan University, Chengdu, Sichuan Province, China

The recently released CONTINUUM trial was the first phase 3 randomized study to demonstrate the efficacy and safety of immunotherapy in high-risk locoregionally advanced nasopharyngeal carcinoma (NPC), showing that sintilimab can bring clinical benefits to these populations.We developed a Markov model to assess the cost and effectiveness of sintilimab plus standard therapy versus standard therapy alone. The primary outcomes included total costs, life-years, quality adjusted life years (QALYs) and incremental cost-effective ratios (ICERs). A series of sensitivity analyses were conducted to test the stability of the model. Subgroup analysis was conducted based on different programmed cell death 1 ligand 1 (PD-L1) expression and Epstein-Barr virus (EBV) DNA levels.Results: When compared to standard therapy, the addition of sintilimab yielded extra 3.10 QALYs at an increased cost of $24208.60, resulting in an ICER of $7819.669 per QALY. Our one-way sensitivity analysis indicated that the utility of event-free survival and the risk of leukopenia/neutropenia in immunotherapy group were the most influential factors impacting the results. The incorporation of sintilimab alongside standard therapy demonstrated a 95.4% probability of being cost-effective.Furthermore, subgroup analysis revealed that sintilimab regimen was cost-effective across different expression levels of PD-L1 and EBV-DNA.First-line induction-concurrent chemoradiotherapy with sintilimab was identified as a cost-effectiveness treatment option for high-risk locoregionally advanced NPC.