Cost-effectiveness of PD-1 inhibitors combined with chemotherapy for first-line treatment of oesophageal squamous cell carcinoma in China: a comprehensive analysis

Programmed death-1 (PD-1) inhibitors combined with chemotherapy have become a standard first-line treatment for advanced oesophageal squamous cell carcinoma (ESCC). Given the high costs associated with immunotherapy, evaluating the cost-effectiveness of different PD-1 inhibitors in the Chinese healthcare setting is essential for guiding treatment decisions and policy development. A cost-effectiveness analysis was conducted comparing six PD-1 inhibitors—sintilimab, toripalimab, tislelizumab, camrelizumab, serplulimab, and pembrolizumab—combined with chemotherapy for first-line treatment of advanced ESCC. A partitioned survival model was used to calculate incremental cost-effectiveness ratios (ICERs) from healthcare system perspective, with a willingness-to-pay (WTP) threshold set at $36,598.19 per quality-adjusted life year (QALY). Sensitivity analyses were performed to evaluate the robustness of the results. The ICERs for toripalimab, camrelizumab, pembrolizumab, serplulimab, sintilimab, and tislelizumab were $32,356.79/QALY, $48,410.64/QALY, $312,743.54/QALY, $121,200.84/QALY, $29,663.42/QALY, and $35,304.33/QALY, respectively. Sintilimab, toripalimab, and tislelizumab were below the WTP threshold. Among all regimens, the top three in life years (LYs) gained were toripalimab, serplulimab, and tislelizumab. Sensitivity analysis showed that utility values and drug prices were key factors influencing ICERs. Probabilistic analysis indicated that toripalimab, sintilimab, and tislelizumab had the highest probabilities of being cost-effective, at 83.1%, 81.4%, and 70.0%, respectively. Sintilimab, toripalimab, and tislelizumab are the most cost-effective PD-1 inhibitors when combined with chemotherapy for the first-line treatment of advanced ESCC in China, with ICERs below the WTP threshold. While all six PD-1 inhibitors demonstrated clinical benefits, pembrolizumab and serplulimab were less favourable from a cost-effectiveness standpoint. Sensitivity analysis confirmed that drug prices and utility values are significant determinants of cost-effectiveness.

程序性死亡蛋白1（PD-1）抑制剂联合化疗已成为晚期食管鳞状细胞癌（ESCC）的标准一线治疗方案。鉴于免疫治疗相关成本高昂，在中国医疗场景下评估不同PD-1抑制剂的成本效益，对于指导治疗决策与政策制定至关重要。本研究开展了一项成本效益分析，对比六种PD-1抑制剂——信迪利单抗、特瑞普利单抗、替雷利珠单抗、卡瑞利珠单抗、赛帕利单抗与帕博利珠单抗——联合化疗用于晚期ESCC一线治疗的效果。研究采用分区生存模型（partitioned survival model），从医疗体系视角计算增量成本效益比（ICERs），并将支付意愿（WTP）阈值设定为每质量调整生命年（QALY）36598.19美元。此外开展了敏感性分析以评估研究结果的稳健性。六种方案的增量成本效益比分别为：特瑞普利单抗32356.79美元/QALY、卡瑞利珠单抗48410.64美元/QALY、帕博利珠单抗312743.54美元/QALY、赛帕利单抗121200.84美元/QALY、信迪利单抗29663.42美元/QALY、替雷利珠单抗35304.33美元/QALY。其中信迪利单抗、特瑞普利单抗与替雷利珠单抗的ICERs低于WTP阈值。在所有治疗方案中，新增生命年（LYs）排名前三的分别为特瑞普利单抗、赛帕利单抗与替雷利珠单抗。敏感性分析结果显示，效用值与药品价格是影响ICERs的关键因素。概率分析表明，特瑞普利单抗、信迪利单抗与替雷利珠单抗具备成本效益的概率最高，分别为83.1%、81.4%与70.0%。在中国晚期ESCC一线治疗场景中，信迪利单抗、特瑞普利单抗与替雷利珠单抗联合化疗的成本效益最优，其ICERs均低于WTP阈值。尽管六种PD-1抑制剂均展现出临床获益，但帕博利珠单抗与赛帕利单抗的成本效益表现欠佳。敏感性分析进一步证实，药品价格与效用值是影响成本效益的重要决定因素。