Cost-Effectiveness of Dostarlimab Plus Chemotherapy for Primary Advanced or Recurrent Endometrial Cancer From Taiwan’s National Health Insurance Perspective
Author(s)
Chi-Yun Wu, PhD1, Liang-Yi Lin, PhD1, Hsiao-Tung Tsai, MS, PharmD2, Yao-Chun Wen, MSc3, Yi Wen Chang, MD4, Chyong-Huey Lai, MD5, Shih-Tsung Huang, PhD2, Fei-Yuan Sharon Hsiao, PhD6.
1Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan, 2Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan, 3Market Access Manager, GSK Far East B.V., Taipei, Taiwan, 4GSK Far East B.V., Taipei, Taiwan, 5Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan, 6Department of Pharmacy, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
1Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan, 2Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan, 3Market Access Manager, GSK Far East B.V., Taipei, Taiwan, 4GSK Far East B.V., Taipei, Taiwan, 5Gynecologic Cancer Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan, 6Department of Pharmacy, Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
OBJECTIVES: Dostarlimab in combination with carboplatin-paclitaxel (CP) improves progression-free survival and overall survival in patients with primary advanced or recurrent endometrial cancer (pA/rEC), with more pronounced benefits in patients with mismatch repair-deficient (dMMR), microsatellite instability-high (MSI-H) tumors, in the phase III RUBY trial. This study aims to evaluate the cost-effectiveness of dostarlimab plus CP as first-line treatment in the overall pA/rEC population and dMMR/MSI-H patients, from the perspective of Taiwan’s National Health Insurance.
METHODS: A partitioned survival model with three mutually exclusive health states (progression-free disease, progressed disease, death) was used to assess the cost-effectiveness of dostarlimab plus CP compared with standard chemotherapy. Patient outcomes were modeled using one-week cycles for a lifetime horizon. The main clinical efficacy and safety data were derived from the RUBY trial. Cost parameters, including drug administration, monitoring, follow-up, management of adverse events, and subsequent treatment costs, were derived from reliable public sources and expert opinions. The incremental cost-effectiveness ratio (ICER) was calculated using a 3.5% discount rate and a willingness-to-pay threshold (WTP) of TWD3,300,000 (three times Taiwan’s per capita GDP in 2024). Deterministic and probabilistic sensitivity analyses were further conducted to evaluate the robustness of the model.
RESULTS: In the overall pA/rEC population, dostarlimab plus CP yielded an increase of 1.27 QALYs at an additional cost of TWD2,658,988, resulting in an ICER of TWD2,091,936 per QALY in the intention-to-treat cohort. For patients with dMMR/MSI-H tumors, the ICER was TWD856,859/QALY. Sensitivity analyses identified the overall survival benefits of dostarlimab plus CP versus CP as the most influential parameter. At a WTP threshold of TWD3,300,000, dostarlimab plus CP had cost-effectiveness probabilities of 97% and 100% in the overall pA/rEC population and dMMR/MSI-H patients, respectively.
CONCLUSIONS: Dostarlimab plus CP is cost-effective compared to CP alone at the WTP threshold of TWD3,300,000 per QALY, regardless of mismatch repair status.
METHODS: A partitioned survival model with three mutually exclusive health states (progression-free disease, progressed disease, death) was used to assess the cost-effectiveness of dostarlimab plus CP compared with standard chemotherapy. Patient outcomes were modeled using one-week cycles for a lifetime horizon. The main clinical efficacy and safety data were derived from the RUBY trial. Cost parameters, including drug administration, monitoring, follow-up, management of adverse events, and subsequent treatment costs, were derived from reliable public sources and expert opinions. The incremental cost-effectiveness ratio (ICER) was calculated using a 3.5% discount rate and a willingness-to-pay threshold (WTP) of TWD3,300,000 (three times Taiwan’s per capita GDP in 2024). Deterministic and probabilistic sensitivity analyses were further conducted to evaluate the robustness of the model.
RESULTS: In the overall pA/rEC population, dostarlimab plus CP yielded an increase of 1.27 QALYs at an additional cost of TWD2,658,988, resulting in an ICER of TWD2,091,936 per QALY in the intention-to-treat cohort. For patients with dMMR/MSI-H tumors, the ICER was TWD856,859/QALY. Sensitivity analyses identified the overall survival benefits of dostarlimab plus CP versus CP as the most influential parameter. At a WTP threshold of TWD3,300,000, dostarlimab plus CP had cost-effectiveness probabilities of 97% and 100% in the overall pA/rEC population and dMMR/MSI-H patients, respectively.
CONCLUSIONS: Dostarlimab plus CP is cost-effective compared to CP alone at the WTP threshold of TWD3,300,000 per QALY, regardless of mismatch repair status.
Conference/Value in Health Info
2025-09, ISPOR Real-World Evidence Summit 2025, Tokyo, Japan
Value in Health Regional, Volume 49S (September 2025)
Code
RWD131
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Oncology