Data Sheet 1_Cost-effectiveness analysis of the combination of low-dose nivolumab with triple metronomic chemotherapy for advanced head and neck squamous cell carcinoma in China.docx

BackgroundThe combination of low-dose nivolumab with triple metronomic chemotherapy (TMC-I) proposes a novel approach, potentially enhancing patient prognosis while mitigating financial barriers. The purpose of this study was to compare the cost-effectiveness of TMC-I compared to triple metronomic chemotherapy (TMC) in advanced head and neck squamous cell carcinoma (HNSCC) patients in China, the largest developing country.
MethodsA partitioned survival model (PSM) was developed based on a randomized clinical trial. Costs and utility were derived from open-access databases and literatures. The primary outcome was incremental cost-effectiveness ratio (ICER). A willingness-to-pay (WTP) threshold of ¥44,679/QALY based on supply-side and ¥134,037/QALY based on demand-side were set. Sensitivity analyses and scenario analysis were conducted; subgroup analyses were also included.
ResultsTMC-I yielded an additional 0.41 quality-adjusted life years (QALYs) while increasing costs by ¥47,346.98 relative to TMC, leading an ICER of ¥116,374.22/QALY. In scenario analysis which the utilities calculated by the time-to-death (TTD) were adopted, the results showed that the ICER was ¥114,795.25/QALY. In the probabilistic sensitivity analysis, the probabilities that TMC-I was cost-effective at thresholds of ¥134,037/QALY, ¥44,679/QALY gained were 60.9%, 9.4%, respectively. Subgroup analysis results indicated TMC-I was dominated vs. TMC for patients with no previous taxane and PD-L1 score >50.
ConclusionFor Patients with recurrent or newly diagnosed advanced head and neck squamous cell carcinoma, TMC-I is cost-effective at a WTP thresholds of ¥134,037/QALY and is not cost-effective when the WTP thresholds was ¥44,679/QALY compared with TMC.