{"title":"晚期子宫内膜癌患者的免疫疗法加化疗：成本效益分析。","authors":"Youwen Zhu, Kun Liu, Hong Zhu","doi":"10.3802/jgo.2025.36.e6","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Pembrolizumab and dostarlimab are immune checkpoint inhibitors that target programmed death receptor 1 (PD-1). Combination anti-PD-1 regimens have been shown to exhibit favorable survival benefits when treating advanced endometrial cancer (EC). Which treatment was preferable will need to be confirmed by a cost-effectiveness comparison between them.</p><p><strong>Methods: </strong>Based on patient and clinical parameters from RUBY and NRG-GY018 phase III randomized controlled trials, the Markov model with a 20-year time horizon was established to evaluate the cost-effectiveness of dostarlimab plus chemotherapy (DC), pembrolizumab plus chemotherapy (PC), and chemotherapy alone (C) treatment for patients with mismatch repair-proficient microsatellite-stable (pMMR-MSS) and mismatch repair-deficient microsatellite instability-high (dMMR-MSI-H) advanced EC from the American payers' perspective. The main results include total cost, life-years (LYs), quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) at a $150,000/QALY of willingness-to-pay.</p><p><strong>Results: </strong>In the pMMR-MSS population, DC, PC, and C produced costs (QALYs) of $99,205 (3.02), $322,530 (3.25), and $421,923 (4.40), resulting in corresponding ICERs of $974,177/QALY (PC vs. C), $234,527/QALY (DC vs. C), $86,671/QALY (DC vs. PC), respectively; In the dMMR-MSI-H population, DC, PC, and C obtained costs (QALYs) of $120,177 (5.73), $691,399 (8.43), and $708,787 (11.26), yielding ICERs of $266,423/QALY (PC vs. C), $135,165/QALY (DC vs. C), $7,866/QALY (DC vs. PC), respectively.</p><p><strong>Conclusion: </strong>In the US, DC was a more cost-effective treatment than PC for patients with advanced EC irrespective of MMR status. 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Which treatment was preferable will need to be confirmed by a cost-effectiveness comparison between them.</p><p><strong>Methods: </strong>Based on patient and clinical parameters from RUBY and NRG-GY018 phase III randomized controlled trials, the Markov model with a 20-year time horizon was established to evaluate the cost-effectiveness of dostarlimab plus chemotherapy (DC), pembrolizumab plus chemotherapy (PC), and chemotherapy alone (C) treatment for patients with mismatch repair-proficient microsatellite-stable (pMMR-MSS) and mismatch repair-deficient microsatellite instability-high (dMMR-MSI-H) advanced EC from the American payers' perspective. The main results include total cost, life-years (LYs), quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) at a $150,000/QALY of willingness-to-pay.</p><p><strong>Results: </strong>In the pMMR-MSS population, DC, PC, and C produced costs (QALYs) of $99,205 (3.02), $322,530 (3.25), and $421,923 (4.40), resulting in corresponding ICERs of $974,177/QALY (PC vs. C), $234,527/QALY (DC vs. C), $86,671/QALY (DC vs. PC), respectively; In the dMMR-MSI-H population, DC, PC, and C obtained costs (QALYs) of $120,177 (5.73), $691,399 (8.43), and $708,787 (11.26), yielding ICERs of $266,423/QALY (PC vs. C), $135,165/QALY (DC vs. C), $7,866/QALY (DC vs. PC), respectively.</p><p><strong>Conclusion: </strong>In the US, DC was a more cost-effective treatment than PC for patients with advanced EC irrespective of MMR status. 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引用次数: 0
摘要
目的Pembrolizumab和dostarlimab是针对程序性死亡受体1（PD-1）的免疫检查点抑制剂。在治疗晚期子宫内膜癌（EC）时，联合抗 PD-1 方案已显示出良好的生存优势。哪种治疗方法更可取，需要通过对它们进行成本效益比较来确认：方法：根据 RUBY 和 NRG-GY018 III 期随机对照试验的患者和临床参数，建立了 20 年时间跨度的马尔可夫模型，以评估多斯他利单抗联合化疗（DC）、pembrolizumab 联合化疗（PC）和单纯化疗（C）的成本效益、和单纯化疗（C）治疗错配修复缺陷微卫星稳定型（pMMR-MSS）和错配修复缺陷微卫星不稳定性高型（dMMR-MSI-H）晚期EC患者的成本效益。主要结果包括总成本、生命年数（LYs）、质量调整生命年数（QALYs），以及以15万美元/QALY的支付意愿计算的增量成本效益比（ICER）：在 pMMR-MSS 群体中，DC、PC 和 C 产生的成本（QALY）分别为 99,205 美元（3.02）、322,530 美元（3.25）和 421,923 美元（4.40），相应的 ICER 分别为 974,177 美元/QALY（PC vs. C）、234,527 美元/QALY（DC vs. C）、86,671 美元/QALY（DC vs. PC）；在 dMMR-MSS 群体中，DC、PC 和 C 产生的成本（QALY）分别为 99,205 美元（3.02）、322,530 美元（3.25）和 421,923 美元（4.40）。在dMMR-MSI-H人群中，DC、PC和C的成本（QALY）分别为120,177美元（5.73）、691,399美元（8.43）和708,787美元（11.26），ICER分别为266,423美元/QALY（PC vs. C）、135,165美元/QALY（DC vs. C）、7,866美元/QALY（DC vs. PC）：在美国，对晚期EC患者而言，无论MMR状态如何，DC比PC更具成本效益。然而，与C相比，DC在dMMR-MSI-H人群中更具成本效益。
Immunotherapy plus chemotherapy in patients with advanced endometrial cancer: a cost-effectiveness analysis.
Objective: Pembrolizumab and dostarlimab are immune checkpoint inhibitors that target programmed death receptor 1 (PD-1). Combination anti-PD-1 regimens have been shown to exhibit favorable survival benefits when treating advanced endometrial cancer (EC). Which treatment was preferable will need to be confirmed by a cost-effectiveness comparison between them.
Methods: Based on patient and clinical parameters from RUBY and NRG-GY018 phase III randomized controlled trials, the Markov model with a 20-year time horizon was established to evaluate the cost-effectiveness of dostarlimab plus chemotherapy (DC), pembrolizumab plus chemotherapy (PC), and chemotherapy alone (C) treatment for patients with mismatch repair-proficient microsatellite-stable (pMMR-MSS) and mismatch repair-deficient microsatellite instability-high (dMMR-MSI-H) advanced EC from the American payers' perspective. The main results include total cost, life-years (LYs), quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) at a $150,000/QALY of willingness-to-pay.
Results: In the pMMR-MSS population, DC, PC, and C produced costs (QALYs) of $99,205 (3.02), $322,530 (3.25), and $421,923 (4.40), resulting in corresponding ICERs of $974,177/QALY (PC vs. C), $234,527/QALY (DC vs. C), $86,671/QALY (DC vs. PC), respectively; In the dMMR-MSI-H population, DC, PC, and C obtained costs (QALYs) of $120,177 (5.73), $691,399 (8.43), and $708,787 (11.26), yielding ICERs of $266,423/QALY (PC vs. C), $135,165/QALY (DC vs. C), $7,866/QALY (DC vs. PC), respectively.
Conclusion: In the US, DC was a more cost-effective treatment than PC for patients with advanced EC irrespective of MMR status. However, compared to C, DC was associated with more cost-effectiveness in the dMMR-MSI-H population.
期刊介绍：
The Journal of Gynecologic Oncology (JGO) is an official publication of the Asian Society of Gynecologic Oncology. Abbreviated title is ''J Gynecol Oncol''. It was launched in 1990. The JGO''s aim is to publish the highest quality manuscripts dedicated to the advancement of care of the patients with gynecologic cancer. It is an international peer-reviewed periodical journal that is published bimonthly (January, March, May, July, September, and November). Supplement numbers are at times published. The journal publishes editorials, original and review articles, correspondence, book review, etc.
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