ArticlePloS one2025
First-line durvalumab therapy alone or in combination with tremelimumab for metastatic head and neck squamous cell carcinoma: A cost-effectiveness analysis.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveIn patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC), the KESTREL study evaluated durvalumab with or without tremelimumab, as well as the EXTREME regimen (platinum, 5-fluorouracil, and cetuximab). In the first-line treatment of R/M HNSCC, no data are available regarding the cost-effectiveness of these immunotherapeutic agents. Based on third-party payers' perspectives in the United States, we compared durvalumab and tremelimumab in this setting.
methodsThe projected costs and outcomes over a 12-year period were calculated using a three-state partitioned survival model with an annual discount of 3%. Long-term extrapolation of KESTREL was used to model progression-free and overall survival. Life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), incremental net monetary benefits (INMBs), and incremental net health benefits (INHBs) were calculated. The uncertainty and stability of the model were examined using one-way and probabilistic sensitivity analyses.
resultsIn the overall population, EXTREME was dominant compared to durvalumab plus tremelimumab (Durva-Treme). Compared to durvalumab monotherapy (Durva-mono), EXTREME resulted in an increase of 0.037 life-years and 0.012 QALYs, as well as an increase in cost of $85,420 per patient. The corresponding ICER was $7,310,878/QALY, and the INHB and INMB values were negative at a willingness to pay threshold of $150,000/QALY. Furthermore, Durva-mono dominated EXTREME or Durva-Treme in patients with high PD-L1 expression. When compared with EXTREME, Durva-Treme had an ICER of $560,406/QALY. Durva-Treme was unlikely to be cost-effective. The HRs for OS, PFS, and drug costs (cetuximab, tremelimumab, and durvalumab) were most sensitive to the model. The results of the sensitivity analyses were similar, suggesting the robustness of the findings.
conclusionsDurva-mono is a cost-effective treatment strategy for patients with R/M HNSCC, particularly in patients with high PD-L1 expression, compared with EXTREME or Durva-Treme. Cetuximab cost reduction may benefit the EXTREME regimen economically. Nevertheless, Durva-Treme provided fewer survival gains at substantial additional costs; therefore, it is unlikely to be a cost-effective option.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.