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. 2026 Feb 18:64:102050.
doi: 10.1016/j.gore.2026.102050. eCollection 2026 Apr.

Cost effectiveness analysis of immunotherapy regimens currently approved in advanced or recurrent endometrial cancer: An analysis of the NRG-GY 018, RUBY, and DUO-E trials

Alex A Francoeur  1 , Su-Ying Liang  2 , Brittany File  1 , Eunji Choi  3 , Max Brameld  2 , Michael T Richardson  4 , Caitlin R Johnson  2 , Daniel S Kapp  5 , Krishnansu S Tewari  1 , John K Chan  6
Affiliations

Cost effectiveness analysis of immunotherapy regimens currently approved in advanced or recurrent endometrial cancer: An analysis of the NRG-GY 018, RUBY, and DUO-E trials

Alex A Francoeur et al. Gynecol Oncol Rep. .

Abstract

Background: The purpose of this project was to evaluate the cost-effectiveness of novel FDA approved regimens incorporating immunotherapy into upfront treatment with chemotherapy in advanced or recurrent endometrial cancer in the mismatch repair deficient (dMMR) and mismatch repair proficient (pMMR) cohorts.

Methods: Partitioned survival models were established based on the RUBY, NRG-GY 018, and DUO-E trials, as well as available FDA data. Incremental cost-effectiveness ratios (ICERs) were estimated based on quality adjusted progression free life years saved (QA-PFLYS). Tree Age software was used to perform partitioned survival modeling. Outcomes for dMMR and pMMR groups were compared based on the current FDA approvals. Costs were obtained from Redbook Micromedex pricing and adjusted for inflation from study activation to public dissemination of trial results.

Results: The addition of pembrolizumab, dostarlimab, or durvalumab to chemotherapy in patients with dMMR tumors resulted in improvements in progression free life years saved. Based on QA-PFLYS, the ICER for pembrolizumab was $217,713, followed by $351,280 for durvalumab, and $451,750 for dostarlimab. When continuing durvalumab for 2 years, the ICER was $262,087. When looking at patients with pMMR tumors, the ICER for pembrolizumab was $250,535 while the ICER for dostarlimab was $1,349,776.

Conclusions: Recognizing existing differences in study design, both pembrolizumab and durvalumab may be more cost effective than dostarlimab in our model. This appears to largely be driven by differences in duration of maintenance therapy rather than differences in effectiveness or individual drug cost. Immunotherapy does not appear to be as cost effective in the pMMR population.

Keywords: Advanced endometrial cancer; Cost effectiveness; Dostarlimab; Durvalumab; Immunotherapy; Pembrolizumab; Recurrent endometrial cancer.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Example of a partitioned survival model, using overall survival (OS) and progress-free survival (PFS) curves to determine a three-state membership at a given time. Abbreviations PF: progression-free; PP: post-progression. PP(t)=OS(t)-PFS(t).
Fig. 2
Fig. 2
One-way sensitivity analysis of each model assessing at what cost each medication regimen could be considered cost effective assuming a willingness to pay threshold of $100,000. A. Sensitivity analysis of pembrolizumab and chemotherapy for patients with dMMR mutations. B. Sensitivity analysis of pembrolizumab and chemotherapy for patients with pMMR mutations. C. Sensitivity analysis of dostarlimab and chemotherapy for patients with dMMR mutations. D. Sensitivity analysis of dostarlimab and chemotherapy for patients with pMMR mutations. E. Sensitivity analysis of durvalumab and chemotherapy for patients with dMMR mutations with 2 years of maintenance. F. Sensitivity analysis of durvalumab and chemotherapy for patients with dMMR mutations with 3 years of maintenance.
Fig. 2
Fig. 2
One-way sensitivity analysis of each model assessing at what cost each medication regimen could be considered cost effective assuming a willingness to pay threshold of $100,000. A. Sensitivity analysis of pembrolizumab and chemotherapy for patients with dMMR mutations. B. Sensitivity analysis of pembrolizumab and chemotherapy for patients with pMMR mutations. C. Sensitivity analysis of dostarlimab and chemotherapy for patients with dMMR mutations. D. Sensitivity analysis of dostarlimab and chemotherapy for patients with pMMR mutations. E. Sensitivity analysis of durvalumab and chemotherapy for patients with dMMR mutations with 2 years of maintenance. F. Sensitivity analysis of durvalumab and chemotherapy for patients with dMMR mutations with 3 years of maintenance.
Fig. 2
Fig. 2
One-way sensitivity analysis of each model assessing at what cost each medication regimen could be considered cost effective assuming a willingness to pay threshold of $100,000. A. Sensitivity analysis of pembrolizumab and chemotherapy for patients with dMMR mutations. B. Sensitivity analysis of pembrolizumab and chemotherapy for patients with pMMR mutations. C. Sensitivity analysis of dostarlimab and chemotherapy for patients with dMMR mutations. D. Sensitivity analysis of dostarlimab and chemotherapy for patients with pMMR mutations. E. Sensitivity analysis of durvalumab and chemotherapy for patients with dMMR mutations with 2 years of maintenance. F. Sensitivity analysis of durvalumab and chemotherapy for patients with dMMR mutations with 3 years of maintenance.
Fig. 2
Fig. 2
One-way sensitivity analysis of each model assessing at what cost each medication regimen could be considered cost effective assuming a willingness to pay threshold of $100,000. A. Sensitivity analysis of pembrolizumab and chemotherapy for patients with dMMR mutations. B. Sensitivity analysis of pembrolizumab and chemotherapy for patients with pMMR mutations. C. Sensitivity analysis of dostarlimab and chemotherapy for patients with dMMR mutations. D. Sensitivity analysis of dostarlimab and chemotherapy for patients with pMMR mutations. E. Sensitivity analysis of durvalumab and chemotherapy for patients with dMMR mutations with 2 years of maintenance. F. Sensitivity analysis of durvalumab and chemotherapy for patients with dMMR mutations with 3 years of maintenance.
Fig. 2
Fig. 2
One-way sensitivity analysis of each model assessing at what cost each medication regimen could be considered cost effective assuming a willingness to pay threshold of $100,000. A. Sensitivity analysis of pembrolizumab and chemotherapy for patients with dMMR mutations. B. Sensitivity analysis of pembrolizumab and chemotherapy for patients with pMMR mutations. C. Sensitivity analysis of dostarlimab and chemotherapy for patients with dMMR mutations. D. Sensitivity analysis of dostarlimab and chemotherapy for patients with pMMR mutations. E. Sensitivity analysis of durvalumab and chemotherapy for patients with dMMR mutations with 2 years of maintenance. F. Sensitivity analysis of durvalumab and chemotherapy for patients with dMMR mutations with 3 years of maintenance.
Fig. 2
Fig. 2
One-way sensitivity analysis of each model assessing at what cost each medication regimen could be considered cost effective assuming a willingness to pay threshold of $100,000. A. Sensitivity analysis of pembrolizumab and chemotherapy for patients with dMMR mutations. B. Sensitivity analysis of pembrolizumab and chemotherapy for patients with pMMR mutations. C. Sensitivity analysis of dostarlimab and chemotherapy for patients with dMMR mutations. D. Sensitivity analysis of dostarlimab and chemotherapy for patients with pMMR mutations. E. Sensitivity analysis of durvalumab and chemotherapy for patients with dMMR mutations with 2 years of maintenance. F. Sensitivity analysis of durvalumab and chemotherapy for patients with dMMR mutations with 3 years of maintenance.
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