Immune checkpoint inhibition in first-line treatment for recurrent or metastatic nasopharyngeal carcinoma: A CAPTAIN-1st and JUPITER-02 trial-based cost-effectiveness analysis

Objectives: This study was aimed to evaluate the cost-effectiveness of the recently approved first-line treatments, toripalimab or camrelizumab combined with gemcitabine plus cisplatin² (GP) and GP alone for patients with recurrent or metastatic nasopharyngeal carcinoma³ (RM-NPC) from the Chinese payers' perspective.

Materials and methods: We established a Markov model to estimate the cost and effectiveness of currently first-line therapies for RM-NPC. Survival data were derived from the CAPTAIN-1st and JUPITER-02 trials. Direct medical costs and utilities were collected from the published literature and standard fee database. Main outcomes were total costs, quality-adjusted life-year⁴ (QALY), and incremental cost-effectiveness ratios (ICER) at a willingness-to-pay⁵ (WTP) of $34 066/QALY. The robustness of the model was assessed by performing one-way and probability sensitivity analyses.

Results: Compared with the GP chemotherapy, toripalimab or camrelizumab plus GP chemotherapy as first-line therapy for RM-NPC provided an incremental cost of $6 026 and $43 138 with additional 0.90 QALYs and 0.78 QALYs, respectively, resulting in an ICER of 6 696 $/QALY and 55 305 $/QALY. In the pairwise comparison between the two immunotherapy-related groups, toripalimab plus GP was the dominant strategy with lower costs and higher efficiency than the camrelizumab plus GP group.

Conclusion: In our analysis, compared with GP chemotherapy alone, toripalimab plus GP was more cost-effective, while camrelizumab plus GP chemotherapy was not cost-effective. In the pairwise comparison between the two immunotherapy-related groups, toripalimab plus GP would be more cost-effective than camrelizumab plus GP chemotherapy.