PMID- 38425370
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240302
IS  - 1756-283X (Print)
IS  - 1756-2848 (Electronic)
IS  - 1756-283X (Linking)
VI  - 17
DP  - 2024
TI  - Immune checkpoint inhibitors versus chemotherapy as second-line therapy for 
      advanced oesophageal squamous cell carcinoma: a systematic review and economic 
      evaluation.
PG  - 17562848241233134
LID - 10.1177/17562848241233134 [doi]
LID - 17562848241233134
AB  - BACKGROUND: Recently, several novel programmed cell death protein 1 (PD-1) 
      inhibitors have been approved for second-line treating advanced or metastatic 
      oesophageal squamous cell carcinoma (OSCC), including camrelizumab, nivolumab, 
      pembrolizumab, sintilimab and tislelizumab. However, the optimal treatment 
      regimen remained ambiguous. OBJECTIVES: The purpose of this study was to 
      investigate the efficacy, safety and economy of available PD-1 inhibitors to 
      determine the optimal treatment from the Chinese healthcare system perspective. 
      DESIGN: A systematic review and economic evaluation. DATA SOURCES AND METHODS: A 
      systematic review was undertaken utilizing PubMed, Web of Science, Cochrane 
      Library, Embase and Scopus databases to identify eligible studies until 31 August 
      2023. Primary outcomes were progression-free survival (PFS), overall survival 
      (OS) and adverse events (AEs). We also developed a partitioned survival model at 
      3-week intervals based on five clinical trials to predict long-term costs, 
      quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios for 
      various treatment options. Direct medical costs and utility values were obtained 
      from public drug bidding databases, clinical trials or published literature. The 
      parameter uncertainties within the model were determined via one-way and 
      probabilistic sensitivity analyses. RESULTS: Five randomized controlled trials 
      involving 2837 patients were included in the analysis. Compared with other 
      treatments examined, camrelizumab provided the best PFS benefits [hazard ratio 
      (HR): 0.69, 95% confidence interval (CI): 0.56-0.86], and pembrolizumab provided 
      the best OS benefits (HR: 0.55, 95% CI: 0.37-0.82). Nivolumab caused a relatively 
      lower incidence of treatment-related AEs (HR: 0.10, 95% CI: 0.05-0.20) and grade 
      3-5 AEs (HR: 0.13, 95% CI: 0.08-0.21) than other immunotherapy regimens. In the 
      economic evaluation, average 10-year costs ranged from $5,433.86 (chemotherapy) 
      to $50,617.95 (nivolumab) and mean QALYs ranged from 0.55 (chemotherapy) to 0.82 
      (camrelizumab). Pembrolizumab was eliminated because of dominance. Of the 
      remaining strategies, when the willingness-to-pay thresholds were 1, 2 and 3 
      times GDP per capita in 2022, sintilimab, tislelizumab and camrelizumab were the 
      most cost-effective treatment options, respectively. CONCLUSION: Sintilimab might 
      be the optimal treatment alternative for second-line therapy of advanced OSCC in 
      China, followed by tislelizumab and camrelizumab. TRIAL REGISTRATION: This study 
      has been registered on the PROSPERO database with the registration number 
      CRD42023495204.
CI  - (c) The Author(s), 2024.
FAU - Liu, Shixian
AU  - Liu S
AD  - Centre for Health Management and Policy Research, School of Public Health, 
      Cheeloo College of Medicine, Shandong University, Jinan, China.
AD  - NHC Key Laboratory of Health Economics and Policy Research (Shandong University), 
      Jinan, China.
AD  - Center for Health Preference Research, Shandong University, Jinan, China.
FAU - Dou, Lei
AU  - Dou L
AD  - Centre for Health Management and Policy Research, School of Public Health, 
      Cheeloo College of Medicine, Shandong University, Jinan, China.
AD  - NHC Key Laboratory of Health Economics and Policy Research (Shandong University), 
      Jinan, China.
AD  - Center for Health Preference Research, Shandong University, Jinan, China.
FAU - Li, Shunping
AU  - Li S
AUID- ORCID: 0000-0001-8144-6220
AD  - Centre for Health Management and Policy Research, School of Public Health, 
      Cheeloo College of Medicine, Shandong University, Jinan, China.
AD  - NHC Key Laboratory of Health Economics and Policy Research (Shandong University), 
      Jinan, China.
AD  - Center for Health Preference Research, Shandong University, Jinan, China.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20240228
PL  - England
TA  - Therap Adv Gastroenterol
JT  - Therapeutic advances in gastroenterology
JID - 101478893
PMC - PMC10903196
OAB - Immune checkpoint inhibitors versus chemotherapy as second-line therapy for 
      advanced esophageal squamous cell carcinoma: a systematic review and economic 
      evaluation Background: The purpose of this study was to investigate the efficacy, 
      safety and economy of available PD-1 inhibitors to determine the optimal 
      treatment from the Chinese healthcare system perspective. METHODS: A systematic 
      review was undertaken utilizing PubMed, Web of Science, Cochrane Library, Embase, 
      and Scopus databases to identify eligible studies until August 31, 2023. Primary 
      outcomes were progression-free survival (PFS), overall survival (OS), and adverse 
      events (AEs). We also developed a partitioned survival model at 3-week intervals 
      based on 5 clinical trials to predict long-term costs, quality-adjusted 
      life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) for various 
      treatment options. Direct medical costs and utility values were obtained from 
      public drug bidding database, clinical trials or published literatures. The 
      parameter uncertainties within the model were determined via one-way and 
      probabilistic sensitivity analyses. RESULTS: Compared with other treatments 
      examined, camrelizumab provided the best PFS benefits (HR: 0.69, 95% CI: 
      0.56-0.86), and pembrolizumab provided the best OS benefits (HR: 0.55, 95% CI: 
      0.37-0.82). Nivolumab caused a relatively lower incidence of treatment-related 
      AEs (HR: 0.10, 95% CI: 0.05-0.20) and grade 3-5 AEs (HR: 0.13, 95% CI: 0.08-0.21) 
      than other immunotherapy regimens. In the economic evaluation, average 10-year 
      costs ranged from $5,433.86 (chemotherapy) to $50,617.95 (nivolumab) and mean 
      QALYs ranged from 0.55 (chemotherapy) to 0.82 (camrelizumab). Pembrolizumab was 
      eliminated because of dominance. Of the remaining strategies, when the 
      willingness-to-pay thresholds were 1, 2, and 3 times GDP per capita in 2022, 
      sintilimab, tislelizumab, and camrelizumab were the most cost-effective treatment 
      options, respectively. CONCLUSION: Sintilimab might be the optimal treatment 
      alternative for second-line therapy of advanced ESCC in China, followed by 
      tislelizumab and camrelizumab.
OABL- eng
OTO - NOTNLM
OT  - cost-effectiveness
OT  - immune checkpoint inhibitor
OT  - immunotherapy
OT  - meta-analysis
OT  - oesophageal squamous cell carcinoma
OT  - second-line therapy
COIS- The authors declare that there is no conflict of interest.
EDAT- 2024/03/01 06:44
MHDA- 2024/03/01 06:45
PMCR- 2024/02/28
CRDT- 2024/03/01 03:44
PHST- 2023/11/15 00:00 [received]
PHST- 2024/01/20 00:00 [accepted]
PHST- 2024/03/01 06:45 [medline]
PHST- 2024/03/01 06:44 [pubmed]
PHST- 2024/03/01 03:44 [entrez]
PHST- 2024/02/28 00:00 [pmc-release]
AID - 10.1177_17562848241233134 [pii]
AID - 10.1177/17562848241233134 [doi]
PST - epublish
SO  - Therap Adv Gastroenterol. 2024 Feb 28;17:17562848241233134. doi: 
      10.1177/17562848241233134. eCollection 2024.