Related Experiment Video
Updated: Jan 9, 2026
Detection of a Circulating MicroRNA Custom Panel in Patients with Metastatic Colorectal Cancer
Published on: March 14, 2019
The cost-effectiveness analysis of immune checkpoint inhibitors for microsatellite instability-high/mismatch repair
Pei Yang1,2,3, Zhengda Pei4, Yuan Zhou5,6
1Department of General Surgery, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
Abstract:
Research probing the clinical utility of immune checkpoint inhibitors (ICIs) supports the development of novel, efficacious approaches to treating colorectal cancer (CRC) patients without chemotherapy. Therapeutic innovations, however, need to be evaluated in light of real-world economic considerations. This study compared the cost-effectiveness of first-line dual-immunotherapies, single immunotherapy, and chemotherapies in the treatment of microsatellite-instability-high/mismatch repair deficient (MSI-H/dMMR) advanced CRC from the perspective of American healthcare systems. Individual patient data (IPD) from the KEYNOTE-177 and CheckMate-8HW trials were collected with IPDfromKM and used to develop a Markov model with a 30-year duration and three mutually exclusive health states, providing a framework for the evaluation of the cost-effectiveness of first-line nivolumab together with ipilimumab, pembrolizumab, and chemotherapy for treating MSI-H/dMMR advanced CRC. Primary outcomes consisted of total costs, life years (LYs), quality-adjusted LYs (QALYs), incremental cost-effectiveness ratio (ICER) values, and incremental net-health benefits (INHB) at willingness-to-pay (WTP) thresholds of $100,000/QALY in the USA. Nivolumab plus ipilimumab ($482,416 [18.72 QALYs]) and pembrolizumab ($336,617 [12.21 QALYs]) increased cost (effectiveness) by $145,800 (5.30 QALYs) than chemotherapy ($374,728 [10.07 QALYs]), respectively. The corresponding ICER was $13,670/QALY and -$14,768/QALY, with INHB of 2.52 and 6.80 QALYs, respectively. It was further found that the ICER and INHB of nivolumab plus ipilimumab versus pembrolizumab were $22,386/QALY and 3.84 QALYs, respectively. In addition, the established model is stable. First-line immunotherapeutic treatments for MSI-H/dMMR advanced CRC cases in the USA appears to be cost-effective, with a dual-immunotherapeutic regimen consisting of nivolumab plus ipilimumab being preferable.
Insights
First-line immunotherapy, including nivolumab plus ipilimumab, is cost-effective for advanced colorectal cancer (CRC) with MSI-H/dMMR mutations in the USA. Dual immunotherapy demonstrates preferable outcomes compared to single immunotherapy or chemotherapy.
Area of Science:
- Oncology
- Health Economics
- Clinical Research
Background:
- Immune checkpoint inhibitors (ICIs) offer novel treatment avenues for colorectal cancer (CRC) patients, potentially avoiding chemotherapy.
- Evaluating the economic viability of these therapeutic innovations is crucial for real-world application.
- This study focuses on microsatellite-instability-high/mismatch repair deficient (MSI-H/dMMR) advanced CRC, a specific subtype.
Purpose of the Study:
- To compare the cost-effectiveness of first-line dual-immunotherapies, single immunotherapy, and chemotherapies for MSI-H/dMMR advanced CRC.
- To analyze treatment outcomes from the perspective of American healthcare systems.
- To inform clinical and economic decision-making for CRC treatment strategies.
Main Methods:
- Utilized individual patient data (IPD) from KEYNOTE-177 and CheckMate-8HW trials.
- Developed a 30-year Markov model with three health states.
- Evaluated cost-effectiveness using metrics like QALYs, ICER, and INHB at a $100,000/QALY willingness-to-pay threshold.
Main Results:
- Nivolumab plus ipilimumab and pembrolizumab demonstrated increased cost and effectiveness compared to chemotherapy.
- The incremental cost-effectiveness ratio (ICER) for nivolumab plus ipilimumab versus chemotherapy was $13,670/QALY, with favorable incremental net-health benefits (INHB).
- Nivolumab plus ipilimumab was also found to be preferable to pembrolizumab in terms of ICER and INHB.
Conclusions:
- First-line immunotherapeutic treatments, particularly dual-immunotherapy regimens like nivolumab plus ipilimumab, appear cost-effective for MSI-H/dMMR advanced CRC in the USA.
- The findings support the integration of immunotherapy into standard care for this patient population.
- The study provides a robust economic evaluation framework for novel cancer therapies.
More Related Videos
07:42Patient-Derived Tumor Explants As a "Live" Preclinical Platform for Predicting Drug Resistance in Patients
Published on: February 7, 2021
07:47Author Spotlight: Unveiling Transmembrane Protein Family-Related Markers in Gastric Cancer and Implications for Targeted Therapies
Published on: September 15, 2023