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Dostarlimab for recurrent mismatch repair-deficient endometrial cancer: A cost-effectiveness study
Shayan Dioun1,2, Ling Chen1, Alexander Melamed1,3
1Columbia University College of Physicians and Surgeons, New York, New York, USA.
Objective:
Patients with recurrent endometrial cancer treated with carboplatin and paclitaxel whose disease progresses have few effective treatment options. Based on promising clinical trial data, the anti-programmed cell death 1 (anti-PD-1) antibody dostarlimab was recently granted accelerated approval for endometrial cancer by the US Food and Drug Administration. We developed a decision model to examine the cost-effectiveness of dostarlimab for patients with progressive/recurrent deficient mismatch repair (dMMR) endometrial cancer whose disease has progressed with first-line chemotherapy.
Design:
Cost-effectiveness study.
Population:
Hypothetical cohort of 6000 women with progressive/recurrent dMMR endometrial cancer.
Methods:
The initial decision point in the Markov model was treatment with dostarlimab, pembrolizumab or pegylated liposomal doxorubicin (PLD). Model probabilities, and cost and utility values were derived with assumptions drawn from published literature. Effectiveness was estimated as average quality-adjusted life years (QALYs) gained. One-way, two-way and probabilistic sensitivity analyses were performed to vary the assumptions across a range of plausible values.
Main Outcome Measures:
The primary outcome was the incremental cost-effectiveness ratio (ICER).
Results:
Pegylated liposomal doxorubicin (PLD) was the least costly strategy, at $55,732, followed by dostarlimab ($151,533) and pembrolizumab ($154,597). Based on a willingness-to-pay threshold of $100,000/QALY, PLD was cost-effective compared with dostarlimab, with an ICER of $331,913 per QALY gained for dostarlimab, whereas pembrolizumab was ruled out by extended dominance (less effective, more costly), compared with dostarlimab. In one-way sensitivity analyses, dostarlimab was cost-effective when its cost was reduced to $4905 (52% reduction). These results were robust in a variety of sensitivity analyses.
Conclusions:
Dostarlimab is associated with greater survival compared with other treatments for women with recurrent dMMR endometrial cancer. Although the agent is substantially more costly, dostarlimab became cost-effective when its cost was reduced to $5489 per cycle.
Insights
Dostarlimab offers improved survival for recurrent deficient mismatch repair (dMMR) endometrial cancer but is costly. It becomes cost-effective with a significant price reduction, highlighting the need for accessible pricing for this advanced treatment.
Area of Science:
- Oncology
- Health Economics
- Pharmacoeconomics
Background:
- Recurrent endometrial cancer after carboplatin/paclitaxel has limited treatment options.
- Dostarlimab, an anti-PD-1 antibody, received accelerated FDA approval for endometrial cancer.
- Deficient mismatch repair (dMMR) is a key biomarker in endometrial cancer treatment selection.
Purpose of the Study:
- To evaluate the cost-effectiveness of dostarlimab compared to other treatments for progressive/recurrent dMMR endometrial cancer.
- To analyze the economic value of dostarlimab in a specific patient population.
- To determine the cost-effectiveness threshold for dostarlimab in this indication.
Main Methods:
- A Markov decision model was developed to simulate treatment strategies.
- The model included dostarlimab, pembrolizumab, and pegylated liposomal doxorubicin (PLD).
- Cost and utility data were sourced from published literature; sensitivity analyses were performed.
Main Results:
- PLD was the least expensive strategy ($55,732).
- Dostarlimab ($151,533) and pembrolizumab ($154,597) were more costly.
- At a $100,000/QALY threshold, PLD was cost-effective; dostarlimab's ICER was $331,913/QALY.
Conclusions:
- Dostarlimab demonstrates superior survival benefits for recurrent dMMR endometrial cancer.
- Current pricing makes dostarlimab not cost-effective compared to PLD.
- Dostarlimab could become cost-effective if its price is reduced by over 50%.
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