The randomized GORTEC 2014-01 TPExtreme trial showed no significant improvement in overall survival with TPEx chemotherapy regimen (docetaxel-platinum-cetuximab) versus EXTREME regimen (platinum-fluorouracil-cetuximab) in first-line treatment of recurrent or metastatic head and neck squamous cell carcinoma. However, the TPEx regimen had a favorable safety profile and could provide an alternative to standard of care with the EXTREME regimen in this setting. Our aim was to assess the cost-utility of the TPEx strategy versus EXTREME strategy in the French setting.
We used a decision-analytic semi-Markov model with 4 health states and 1-month cycles. Resource use was prospectively collected in the GORTEC 2014-01 TPExtreme trial (NCT02268695). Transition probabilities were assessed from patient-level data from the trial (n = 539). In the base-case analysis, direct medical costs from the French National Insurance Scheme and quality-adjusted life-years (QALYs) were computed in both arms over an 18-month time horizon to estimate the incremental net monetary benefit. Deterministic sensitivity analysis and probabilistic sensitivity analysis were conducted.
The TPEx regimen was associated with a gain in QALYs (+0.057) and a decrease in cost (−€4 485). In the base-case scenario, the TPEx strategy was dominant over the EXTREME strategy with a positive incremental net monetary benefit amounting to €7349. For a willingness to pay of €50 000 per QALY, the probability of TPEx regimen being cost-effective was 64% and varied between 58% and 67% in the scenario analyses.
The TPEx regimen is likely to be cost-effective compared with EXTREME in the French setting.