A REAL-WORLD PHARMACOECONOMIC EVALUATION OF CAMRELIZUMAB PLUS CHEMOTHERAPY FOR ADVANCED ESOPHAGEAL SQUAMOUS CELL CARCINOMA UNDER THE NATIONAL REIMBURSEMENT DRUG LIST NEGOTIATION POLICY IN CHINA
Author(s)
Hongting Yao, Master of Clinical Pharmacy1, Baolong Ding, Master of Clinical Pharmacy1, Xin Li, PhD2.
1Nanjing Medical University, Nanjing, China, 2Professor, the Director of department of Clinical Pharmacy, Nanjing Medical University, Nanjing, China.
1Nanjing Medical University, Nanjing, China, 2Professor, the Director of department of Clinical Pharmacy, Nanjing Medical University, Nanjing, China.
OBJECTIVES: The indication of camrelizumab plus chemotherapy as first-line treatment for advanced esophageal squamous cell carcinoma (ESCC) was included in China’s National Reimbursement Drug List (NRDL) on March 1, 2023. This study evaluated the real-world effectiveness, safety, and cost-effectiveness of camrelizumab plus chemotherapy before and after NRDL inclusion.
METHODS: A retrospective real-world study was conducted using electronic medical records and mortality data. Patients with advanced ESCC receiving camrelizumab plus chemotherapy or chemotherapy alone were identified. Propensity score matching (PSM) was used to balance baseline characteristics in pre- and post-NRDL cohorts. Overall survival (OS), progression-free survival (PFS), adverse events (AEs), and direct medical costs were assessed. A partitioned survival model was developed to estimate quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses, scenario analyses, and inverse probability of treatment weighting (IPTW) analyses were performed to assess uncertainty and robustness.
RESULTS: In the post-NRDL PSM cohort, 1,476 patients were included (738 per group). Compared with chemotherapy alone, camrelizumab plus chemotherapy improved median OS (13.11 vs. 9.69 months) and median PFS (6.52 vs. 3.97 months). Overall AE rates were 97.02% and 92.55%, while grade ≥3 AE rates were 64.77% and 60.33%, respectively. The post-NRDL ICER was CNY 254,001/QALY, below the willingness-to-pay (WTP) threshold of CNY 298,995/QALY. Deterministic sensitivity analysis identified progression-free survival utility and pre-progression drug costs as the most influential parameters. In contrast, the pre-NRDL ICER was CNY 1,132,745/QALY. NRDL inclusion reduced the ICER by 77.6%. Results were consistent in IPTW analyses.
CONCLUSIONS: Camrelizumab plus chemotherapy improved survival outcomes in real-world patients with advanced ESCC, with a modest increase in adverse events compared with chemotherapy alone. NRDL inclusion substantially improved its economic value, reducing the ICER to below the WTP threshold and supporting its cost-effectiveness from the healthcare system perspective.
METHODS: A retrospective real-world study was conducted using electronic medical records and mortality data. Patients with advanced ESCC receiving camrelizumab plus chemotherapy or chemotherapy alone were identified. Propensity score matching (PSM) was used to balance baseline characteristics in pre- and post-NRDL cohorts. Overall survival (OS), progression-free survival (PFS), adverse events (AEs), and direct medical costs were assessed. A partitioned survival model was developed to estimate quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses, scenario analyses, and inverse probability of treatment weighting (IPTW) analyses were performed to assess uncertainty and robustness.
RESULTS: In the post-NRDL PSM cohort, 1,476 patients were included (738 per group). Compared with chemotherapy alone, camrelizumab plus chemotherapy improved median OS (13.11 vs. 9.69 months) and median PFS (6.52 vs. 3.97 months). Overall AE rates were 97.02% and 92.55%, while grade ≥3 AE rates were 64.77% and 60.33%, respectively. The post-NRDL ICER was CNY 254,001/QALY, below the willingness-to-pay (WTP) threshold of CNY 298,995/QALY. Deterministic sensitivity analysis identified progression-free survival utility and pre-progression drug costs as the most influential parameters. In contrast, the pre-NRDL ICER was CNY 1,132,745/QALY. NRDL inclusion reduced the ICER by 77.6%. Results were consistent in IPTW analyses.
CONCLUSIONS: Camrelizumab plus chemotherapy improved survival outcomes in real-world patients with advanced ESCC, with a modest increase in adverse events compared with chemotherapy alone. NRDL inclusion substantially improved its economic value, reducing the ICER to below the WTP threshold and supporting its cost-effectiveness from the healthcare system perspective.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE706
Topic
Economic Evaluation, Health Policy & Regulatory, Real World Data & Information Systems
Disease
Oncology