ArticleEsophagus : official journal of the Japan Esophageal Society2025
Cost-effectiveness analysis of pembrolizumab plus chemotherapy versus chemotherapy as first line chemotherapy for patients with unresectable advanced esophageal cancer in Japan.
Article in Esophagus : official journal of the Japan Esophageal Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
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8 authors.
Funding
Abstract
backgroundAlthough pembrolizumab plus chemotherapy (Pembro + Chemo) is the recommended first-line therapy for advanced esophageal cancer, it remains unclear whether it is more cost-effective than chemotherapy (Chemo). We evaluated the cost-effectiveness of Pembro + Chemo versus Chemo from a Japanese healthcare payer perspective.
methodsA partitioned survival analysis model was developed to predict costs and quality-adjusted life years (QALY) for Pembro + Chemo and Chemo. The model parameters were based on a previous randomized controlled trial and a nationwide administrative database in Japan. The incremental cost-effectiveness ratio (ICER) of Pembro + Chemo compared with Chemo was estimated. A subgroup analysis on the level of PD-L1 Combined Positive Score (CPS) ≥ 10 was also conducted. Additionally, one-way deterministic sensitivity analysis and probabilistic sensitivity analysis with Monte Carlo simulations (5,000 simulations) were conducted.
resultsThe ICER of Pembro + Chemo over Chemo was estimated at USD 176,479 per QALY. The subgroup analysis for patients with PD-L1 CPS ≥ 10 showed an ICER of USD 126,862 per QALY. One-way deterministic sensitivity analysis demonstrated that the ICER remained above the willingness-to-pay threshold of USD 50,000-100,000 per QALY in all scenarios, with the utility of progression-free survival in the Pembro + Chemo group having the greatest influence on the ICER. Probabilistic sensitivity analysis showed that the probability of Pembro + Chemo being cost-effective was 0% at the willingness-to-pay threshold.
conclusionThe addition of pembrolizumab to chemotherapy was not cost-effective in treating advanced esophageal cancer in Japan.
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