Concurrent chemoradiotherapy with nedaplatin versus cisplatin in stage II-IVB nasopharyngeal carcinoma: A cost-effectiveness analysis. (June 2019)

• Record Type: Journal Article
• Authors: Liao, Weiting; Huang, Jiaxing; Wu, Qiuji; Zhu, Guiqi; Wang, Xinyuan; Wen, Feng; Zhang, Pengfei; Zhang, Nan; Li, Qiu
• Is Part Of: Oral oncology. Volume 93(2019)
• Page Start: 15
• Page End: 20
• Publication Date: 2019-06
• Subjects: Nasopharyngeal carcinoma -- Cost-ineffective -- Chemoradiotherapy -- Nedaplatin -- Markov model -- Economic evaluation; Mouth -- Cancer -- Periodicals; Mouth -- Tumors -- Periodicals; Mouth Diseases -- Periodicals; Mouth Neoplasms -- Periodicals; Bouche -- Cancer -- Périodiques; Bouche -- Tumeurs -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9943105
• DOI: 10.1016/j.oraloncology.2019.04.003
• Languages: English
• ISSNs: 1368-8375

Abstract

Highlights: Lower costs and better QALY outcomes were observed in the cisplatin group than those in the nedaplatin group. The use of nedaplatin for patients with stage II-IVB nasopharyngeal carcinoma, is not cost-effective alternative relative to cisplatin. The results should give hints in the decision-making process to make recommendations regarding the therapy for patients with stage II-IVB nasopharyngeal carcinoma. Abstract: Background: Nedaplatin-based concurrent chemoradiotherapy became an alternative doublet treatment strategy to cisplatin-based concurrent chemoradiotherapy in patients with locoregional, advanced nasopharyngeal carcinoma. Materials and methods: Using a Markov model, we simulated patients with nasopharyngeal carcinoma from disease-free to death. Input data for the model were collected from published literature and the standard fee database of West China Hospital. The outcome was expressed in quality-adjusted-years (QALYs), net monetary benefit at the threshold of $25, 841, three times the Gross Domestic Product of China in 2017. The costs and benefits were discounted at 3% annually and a half-cycle correction was considered. The input parameters were varied in one-way sensitivity analysis to confirm the robustness of the model. All of the primary analyses used second-order probabilistic sensitivity analysis to capture the impact of parameter uncertainty based on 10, 000 Monte-Carlo simulations. Results: The mean QALYs of treatment in stage II-IVB nasopharyngeal carcinoma were comparable: 2.90 QALYs for nedaplatin and 3.12 QALYs for cisplatin. Nedaplatin cost $34, 505 compared with $27, 167 for cisplatin, generating an incremental net monetary benefit of nedaplatin versus cisplatin of $-13, 357 at the ceiling ratio of $25, 841. The results of nedaplatin remained cost-ineffective over the majority of the sensitivity analyses. The cost-effectiveness curve showed that the probability of strategies being cost-effective were 0% for nedaplatin and 100% for cisplatin in stage II-IVB nasopharyngeal carcinoma at any willingness-to-pay threshold. Conclusions: Nedaplatin is a dominated, cost-ineffective alternative to concurrent chemoradiotherapy in stage II-IVB nasopharyngeal carcinoma compared with cisplatin from the perspective of Chinese society.