Pembrolizumab plus chemotherapy in advanced endometrial cancer: a cost-effectiveness analysis
Abstract Objectives Recently, NRG-GY018 clinical trial demonstrated that adding pembrolizumab to chemotherapy led to significantly longer progression-free survival than chemotherapy alone in the first-line treatment of advanced or recurrent endometrial cancer (a/rEC). This analysis aimed to estimate...
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BMC
2025-06-01
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| Series: | Cost Effectiveness and Resource Allocation |
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| Online Access: | https://doi.org/10.1186/s12962-025-00625-9 |
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| author | Xinqiang Zhao Longjiang She Xiaoning Liu Zhenggang Bi |
| author_facet | Xinqiang Zhao Longjiang She Xiaoning Liu Zhenggang Bi |
| author_sort | Xinqiang Zhao |
| collection | DOAJ |
| description | Abstract Objectives Recently, NRG-GY018 clinical trial demonstrated that adding pembrolizumab to chemotherapy led to significantly longer progression-free survival than chemotherapy alone in the first-line treatment of advanced or recurrent endometrial cancer (a/rEC). This analysis aimed to estimate the cost-effectiveness of pembrolizumab plus paclitaxel plus carboplatin chemotherapy (PC) as the first-line treatment for a/rEC in the US and China. Methods A Markov model based on the clinical data from NRG-GY018 trial was established to estimate the cost and efficacy of PC and paclitaxel plus carboplatin groups for a/rEC in mismatch repair-proficient (pMMR) and mismatch repair–deficient (dMMR) populations. Direct medical costs and utility values were collected from the government databases, local databases, and published literatures. The main outcomes were incremental cost-effectiveness ratios (ICERs), incremental monetary benefit (INMB), and incremental net-health benefit (INHB). The robustness of the model was assessed using one-way and probabilistic sensitivity analyses. Results With the 5-year time horizon, treatment with PC gained an additional 0.87 QALYs (1.34 LYs) in pMMR and 4.17 QALYs (5.14 LYs) in the dMMR population. In the US, the ICERs of PC compared to chemotherapy were 404,575 $/QALY in pMMR and 124,406 $/QALY in dMMR patients, respectively. In China, the ICERs of PC compared to chemotherapy were 220,259 $/QALY and 70,207 $/QALY in pMMR and dMMR populations, respectively. The results of sensitivity analyses supported the robustness of our models. Conclusions For patients with a/rEC, PC was cost-effective compared with chemotherapy in the first-line treatment for dMMR populations in the US. However, the combination of pembrolizumab with chemotherapy was not a cost-effective strategy for pMMR a/rEC in the US and a/rEC in China regardless of the MMR status, a price reduction process is required to reach the traditional cost-effectiveness threshold. |
| format | Article |
| id | doaj-art-60fae50a95584787b8bc2191c5ffb625 |
| institution | Kabale University |
| issn | 1478-7547 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Cost Effectiveness and Resource Allocation |
| spelling | doaj-art-60fae50a95584787b8bc2191c5ffb6252025-08-20T03:45:10ZengBMCCost Effectiveness and Resource Allocation1478-75472025-06-0123111010.1186/s12962-025-00625-9Pembrolizumab plus chemotherapy in advanced endometrial cancer: a cost-effectiveness analysisXinqiang Zhao0Longjiang She1Xiaoning Liu2Zhenggang Bi3Department of Orthopedics, First Affiliated Hospital of Harbin Medical UniversityDepartment of Radiation Oncology, The First People’s Hospital of FoshanDepartment of Nutrition, Qingdao Women and Children’s HospitalDepartment of Orthopedics, First Affiliated Hospital of Harbin Medical UniversityAbstract Objectives Recently, NRG-GY018 clinical trial demonstrated that adding pembrolizumab to chemotherapy led to significantly longer progression-free survival than chemotherapy alone in the first-line treatment of advanced or recurrent endometrial cancer (a/rEC). This analysis aimed to estimate the cost-effectiveness of pembrolizumab plus paclitaxel plus carboplatin chemotherapy (PC) as the first-line treatment for a/rEC in the US and China. Methods A Markov model based on the clinical data from NRG-GY018 trial was established to estimate the cost and efficacy of PC and paclitaxel plus carboplatin groups for a/rEC in mismatch repair-proficient (pMMR) and mismatch repair–deficient (dMMR) populations. Direct medical costs and utility values were collected from the government databases, local databases, and published literatures. The main outcomes were incremental cost-effectiveness ratios (ICERs), incremental monetary benefit (INMB), and incremental net-health benefit (INHB). The robustness of the model was assessed using one-way and probabilistic sensitivity analyses. Results With the 5-year time horizon, treatment with PC gained an additional 0.87 QALYs (1.34 LYs) in pMMR and 4.17 QALYs (5.14 LYs) in the dMMR population. In the US, the ICERs of PC compared to chemotherapy were 404,575 $/QALY in pMMR and 124,406 $/QALY in dMMR patients, respectively. In China, the ICERs of PC compared to chemotherapy were 220,259 $/QALY and 70,207 $/QALY in pMMR and dMMR populations, respectively. The results of sensitivity analyses supported the robustness of our models. Conclusions For patients with a/rEC, PC was cost-effective compared with chemotherapy in the first-line treatment for dMMR populations in the US. However, the combination of pembrolizumab with chemotherapy was not a cost-effective strategy for pMMR a/rEC in the US and a/rEC in China regardless of the MMR status, a price reduction process is required to reach the traditional cost-effectiveness threshold.https://doi.org/10.1186/s12962-025-00625-9Advanced endometrial cancerChemotherapyPembrolizumabQuality-adjusted life yearsCost-effectiveness analysis |
| spellingShingle | Xinqiang Zhao Longjiang She Xiaoning Liu Zhenggang Bi Pembrolizumab plus chemotherapy in advanced endometrial cancer: a cost-effectiveness analysis Cost Effectiveness and Resource Allocation Advanced endometrial cancer Chemotherapy Pembrolizumab Quality-adjusted life years Cost-effectiveness analysis |
| title | Pembrolizumab plus chemotherapy in advanced endometrial cancer: a cost-effectiveness analysis |
| title_full | Pembrolizumab plus chemotherapy in advanced endometrial cancer: a cost-effectiveness analysis |
| title_fullStr | Pembrolizumab plus chemotherapy in advanced endometrial cancer: a cost-effectiveness analysis |
| title_full_unstemmed | Pembrolizumab plus chemotherapy in advanced endometrial cancer: a cost-effectiveness analysis |
| title_short | Pembrolizumab plus chemotherapy in advanced endometrial cancer: a cost-effectiveness analysis |
| title_sort | pembrolizumab plus chemotherapy in advanced endometrial cancer a cost effectiveness analysis |
| topic | Advanced endometrial cancer Chemotherapy Pembrolizumab Quality-adjusted life years Cost-effectiveness analysis |
| url | https://doi.org/10.1186/s12962-025-00625-9 |
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