ECONOMICEVALUATION OF TISLELIZUMAB IN COMBINATION WITH GEMCITABINE AND CISPLATIN AS FIRST-LINETREATMENT IN PATIENTS WITH RECURRENT OR METASTATIC NASOPHARYNGEAL CANCER IN THAILAND
Author(s)
Kwandao Malasai, PhD1, Usa Chaikledkaew, PhD2, Jiraphun Jittikoon, PhD3, Wanvisa Udomsinprasert, PhD3.
1Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Maha Sarakham, Thailand, 2Global Health Technology Assessment (GHTA) Research Center, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand, 3Department of Biochemistry, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
1Social Pharmacy Research Unit, Faculty of Pharmacy, Mahasarakham University, Maha Sarakham, Thailand, 2Global Health Technology Assessment (GHTA) Research Center, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand, 3Department of Biochemistry, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
OBJECTIVES: To evaluate the cost-effectiveness of tislelizumab in combination with gemcitabine-cisplatin compared with chemotherapy alone in adults with recurrent or metastatic nasopharyngeal cancer (RM-NPC) in Thailand.
METHODS: A Markov model with monthly cycles was developed to estimate lifetime costs and health outcomes from a societal perspective. Patients received either tislelizumab plus gemcitabine-cisplatin or gemcitabine-cisplatin alone, with tislelizumab continued as maintenance therapy until disease progression and chemotherapy administered for six cycles. Transition probabilities were derived from the RATIONALE-309 trial, and health-state utility values were obtained from published literature. Drug acquisition costs were estimated excluding patient access programs. Costs were estimated in 2025 Thai baht (THB) and discounted at an annual rate of 3%, along with health outcomes. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as the cost per quality-adjusted life-year (QALY) gained.
RESULTS: Tislelizumab plus chemotherapy had incremental lifetime costs of 766,778 THB ($22,733) and 1.46 QALYs, resulting in an ICER of 524,077 THB ($15,537) per QALY gained compared with chemotherapy alone. Tislelizumab in combination with gemcitabine and cisplatin acquisition costs accounted for 502,915 THB ($14,888) per patient over the lifetime horizon.
CONCLUSIONS: While tislelizumab plus gemcitabine-cisplatin was not considered cost-effective as first-line treatment for RM-NPC in Thailand at the current willingness-to-pay threshold of 160,000 THB ($4,744) per QALY, alternative reimbursement arrangements, such as patient access programs or risk-sharing agreements can improve its value proposition.
METHODS: A Markov model with monthly cycles was developed to estimate lifetime costs and health outcomes from a societal perspective. Patients received either tislelizumab plus gemcitabine-cisplatin or gemcitabine-cisplatin alone, with tislelizumab continued as maintenance therapy until disease progression and chemotherapy administered for six cycles. Transition probabilities were derived from the RATIONALE-309 trial, and health-state utility values were obtained from published literature. Drug acquisition costs were estimated excluding patient access programs. Costs were estimated in 2025 Thai baht (THB) and discounted at an annual rate of 3%, along with health outcomes. The primary outcome was the incremental cost-effectiveness ratio (ICER), expressed as the cost per quality-adjusted life-year (QALY) gained.
RESULTS: Tislelizumab plus chemotherapy had incremental lifetime costs of 766,778 THB ($22,733) and 1.46 QALYs, resulting in an ICER of 524,077 THB ($15,537) per QALY gained compared with chemotherapy alone. Tislelizumab in combination with gemcitabine and cisplatin acquisition costs accounted for 502,915 THB ($14,888) per patient over the lifetime horizon.
CONCLUSIONS: While tislelizumab plus gemcitabine-cisplatin was not considered cost-effective as first-line treatment for RM-NPC in Thailand at the current willingness-to-pay threshold of 160,000 THB ($4,744) per QALY, alternative reimbursement arrangements, such as patient access programs or risk-sharing agreements can improve its value proposition.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE690
Topic
Economic Evaluation, Health Technology Assessment
Disease
Oncology, Personalized & Precision Medicine