Cost-effectiveness Analysis of Toripalimab Plus Chemotherapy as First Line Treatment for Advanced Esophageal Squamous Cell Carcinoma

OBJECTIVE To evaluate the cost-effectiveness of combination chemotherapy with toripalimab and placebo as a first-line treatment for advanced esophageal squamous cell carcinoma patients from the perspective of the Chinese health system. METHODS A partitioned survival model with three health states was constructed to analyze the cost-effectiveness of the two schemes. Information on parameters such as cost, health utility and clinical outcome were derived from related websites, published literature and phase III randomized clinical trials of JUPITER-06. The quality-adjusted life year(QALY) was the output index evaluating incremental cost-effectiveness ratio(ICERs), and three times of the per capita gross domestic product in China was selected as the willingness to pay(WTP) threshold to judge whether it was economic. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to assess the robustness of the model. An additional situational analysis was performed to evaluate the economics of toripalimab plus chemotherapy versus sintilimab plus chemotherapy. RESULTS In the basic case, toripalimab plus chemotherapy could improve health outcomes with an augmentation of cost compared with placebo plus chemotherapy in first-line advanced esophageal squamous cell carcinoma patients, resulting the ICERs of ¥ 38 083/QALY. One-way and sensitivity analysis showed that the costs of toripalimab per cycle was the crucial factor in affecting the ICER, and probabilistic sensitivity analyses demonstrated toripalimab plus chemotherapy was 100% cost-effective compared with placebo plus chemotherapy at a WTP threshold of ¥ 257 094 per QALY. The results of situation analysis showed that toripalimab plus chemotherapy was a relatively advantageous regimen compared with sintilimab plus chemotherapy. CONCLUSION From the perspective of Chinese healthcare perspective, first-line treatment with toripalimab plus chemotherapy is a cost-effective option for patients with advanced esophageal squamous cell carcinoma.