Cost-effectiveness of adjuvant therapy with camrelizumab in high-risk locoregionally advanced nasopharyngeal carcinoma: from the perspective of the Chinese healthcare system

OBJECTIVE: Immune checkpoint inhibitors, particularly programmed cell death 1 inhibitors, have shown promising clinical outcomes in the adjuvant treatment of locoregionally advanced nasopharyngeal carcinoma (LA-NPC), offering a more effective and less toxic treatment option. This study aimed to explore the cost-effectiveness of adjuvant immunotherapy with camrelizumab for patients with LA-NPC from the perspective of the Chinese healthcare system. METHODS: A Markov model was developed to evaluate the health and economic outcomes of adjuvant camrelizumab versus standard therapy (observation) in high-risk LA-NPC. Clinical efficacy and safety data were derived from the phase 3 DIPPER trial. The model incorporated three distinct health states and simulated the outcomes over a lifetime horizon. Key endpoints included overall cost, quality-adjusted life year (QALY), incremental cost-effectiveness ratio (ICER), and incremental net health benefit (INHB), assessed at a predefined willingness-to-pay (WTP) threshold of $39,613 per QALY. One-way and probabilistic sensitivity analyses were conducted to assess the robustness of the model. RESULTS: Compared with standard therapy, adjuvant camrelizumab for high-risk patients with LA-NPC resulted in an added 4.39 QALYs at an incremental cost of $21,539, yielding an ICER of $4,910/QALY and an INHB of 3.85 QALYs. At the predefined WTP, camrelizumab demonstrated a 98.6% probability of being a cost-effective adjuvant treatment for LA-NPC in China. The health utility value of event-free survival was the most significant parameter influencing the model results. Sensitivity analysis results supported the robustness of the model. CONCLUSIONS: In China, adjuvant immunotherapy with camrelizumab following induction-concurrent chemoradiotherapy offers a potentially cost-effective approach for the management of patients with high-risk LA-NPC, yielding an ICER significantly below the predefined WTP threshold.