An EARLY Cost-Effectiveness Analysis of Xevinapant in Combination with Chemo-Radiotherapy in Patients with Locally Advanced Squamous Cell Carcinoma of the Head and Neck in United States.
Author(s)
Gandola A1, AIT Sarkouh R1, Orfanos P2, Bouisset F1, Licitra L3
1Debiopharm International SA, Lausanne, VD, Switzerland, 2Debiopharm International SA, Lausanne, Switzerland, 3Head and Neck Medical Oncology, Fondazione IRCCS - Istituto Nazionale Dei Tumori, Milan, Italy
OBJECTIVES : To assess the cost-effectiveness of xevinapant in combination with cisplatin-based chemoradiotherapy (CRT) compared to CRT in the treatment of patients with locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) from the perspective of a US third-party payer. METHODS : A partitioned survival model including progression-free survival, progressive disease (segmented in locoregional or distant relapse) and death health states was used, to estimate the cost-effectiveness of xevinapant plus CRT compared to CRT alone, using time to event data from the Debio 1143-201 phase II, randomized, double-blind, placebo-controlled trial. Weibull distributions were chosen to model PFS and OS, based on optimal statistical and visual fit criterions as well as external clinical evidence. Utility weights for each health state and prominent adverse events were derived from the literature. Disease management resource use estimates were retrieved from Centers for Medicare and Medicaid Services (CMS) data and epidemiological sources. The analysis assumed a 10-year time horizon and a 3% discount rate for both costs and effects. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of results. RESULTS : Xevinapant increases median life expectancy by 1.7 life years (LY) and offers to patients an incremental benefit of 1.8 discounted quality adjusted life years (QALY), due to its superior loco-regional control and PFS. Assuming a cost of treatment at similar levels to other innovative oncology therapies in US, the estimated basecase incremental cost-effectiveness ratio (ICER) was approximately US$ 50,000/QALY. Sensitivity analyses confirmed the robustness of the ICER variation. CONCLUSIONS : Even with a conservative scenario featuring Weibull parametric survival extrapolations for both arms (rather than logarithmic) and a limited time horizon, xevinapant can be classified as a high-value treatment with an ICER around US$ 50,000 willingness-to-pay per QALY threshold range, thus offering superior cost-effectiveness potential compared to any other innovative therapy in this disease area.
Conference/Value in Health Info
2021-05, ISPOR 2021, Montreal, Canada
Value in Health, Volume 24, Issue 5, S1 (May 2021)
Code
PCN72
Topic
Economic Evaluation, Patient-Centered Research
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Patient-reported Outcomes & Quality of Life Outcomes
Disease
Oncology