Economic evaluation of added neoadjuvant cemiplimab to upfront wide local excision for advanced cutaneous squamous cell carcinoma of the head and neck.

Cutaneous squamous cell carcinoma occurs with increasing incidence in the aging United States population and, depending on the tumor stage, can require multimodal treatment. Neoadjuvant cemiplimab has shown promise in improving pathological response and event-free survival, but its cost effectiveness compared with starting with upfront wide local excision has not been explored. This health economics evaluation aims to determine whether adding neoadjuvant cemiplimab may be a more economically valuable intervention in the management of head and neck locoregionally advanced cutaneous squamous cell carcinoma using a decision tree combined with a state-transition Markov model over a 10-year horizon. In the model's base-case analysis, the expected long-term cost per patient was $19,021 lower with the addition of neoadjuvant immunotherapy than with upfront wide local excision alone and yielded 0.11 more quality-adjusted life years, with adjusted time horizon and health utilities leading to the greatest differences in mean costs and quality-adjusted life years, respectively. In this model, neoadjuvant immunotherapy followed by wide local excision was associated with lower expected costs and modestly higher quality-adjusted life years over a 10-year horizon, although the results were sensitive to modeling parameters and assumptions. Future research is needed to clarify long-term costs, outcomes, and corresponding health state utilities.