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. 2020 Nov 6:12:11383-11390.
doi: 10.2147/CMAR.S272149. eCollection 2020.

Cetuximab Plus Chemotherapy versus Chemotherapy Alone in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: A Cost-Effectiveness Analysis

Yitian Lang  1   2 , Deshi Dong  1   2
Affiliations

Cetuximab Plus Chemotherapy versus Chemotherapy Alone in Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: A Cost-Effectiveness Analysis

Yitian Lang et al. Cancer Manag Res. .

Abstract

Objective: The EXTREME clinical trial revealed that cetuximab plus chemotherapy improved the overall survival time of patients with recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) versus chemotherapy alone. The current study examined the cost-effectiveness of cetuximab plus chemotherapy compared with chemotherapy alone in HNSCC patients from the perspective of China.

Materials and methods: A partitioned survival model was implemented for R/M HNSCC patients. Survival information was derived from the CHANGE-2 trial. The model was designed as a ten-year time horizon, a 3-week cycle, and a 3% discount rate for costs and utilities. An incremental cost-effectiveness ratio (ICER) value is less than $30,201/quality-adjusted life-year (QALY) was considered cost-effective in China. We analyzed the uncertainty by performing one-way and probabilistic sensitivity analyses.

Results: In the base-case analysis, we found that the ICER of cetuximab plus chemotherapy compared with chemotherapy alone is $172,702/QALY. The results of one-way sensitivity analysis and probabilistic analysis showed that the fluctuations of each variable in its ranges do not cause ICERs to reach acceptable thresholds.

Conclusion: The current observations suggested that treatment with cetuximab plus chemotherapy is not a cost-effective strategy for R/M HNSCC patients in China at a $30,201 willingness to pay threshold.

Keywords: CHANGE-2; HNSCC; cetuximab; cost-effectiveness; recurrent or metastatic head and neck squamous cell carcinoma.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
The diagram of two therapeutic regimens and three health states transitions in the partitioned survival model.
Figure 2
Figure 2
Diagram of projected PFS and OS fit curves in different regimens. The solid red lines represent the modeled survival curves of cetuximab plus chemotherapy regimen, the solid green lines represent the modeled survival curves of the chemotherapy regimen and the black lines are the actual survival curves. (A) Actual and modeled PFS curve; (B) Actual and modeled OS curve. Each cycle of the x-axis is 3 weeks.
Figure 3
Figure 3
Tornado diagram. The results of one-way sensitivity analysis in the US in the form of a tornado diagram.
Figure 4
Figure 4
Cost-effectiveness acceptable curve. The y-axis indicates the probability that a strategy is cost-effective across the willingness to pay per QALY gained (x-axis).
See this image and copyright information in PMC

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