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 inlocoregional or distant relapse) and death health states was used, to estimate the cost-effectiveness of xevinapant plus CRTcompared 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 criteria aswell as external clinical evidence. Utility weights for each health state and prominent adverse events were derived from the literature. Diseasemanagement resource use estimates were retrieved from Centers for Medicare and Medicaid Services (CMS) data andepidemiological 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 1.66 life years (LY) and offers to patients an incrementalbenefit of 1.80 discounted quality adjusted life years (QALY), due to its superior locoregional control and PFS. Assuming acost 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 confimed the robustness of the ICERvariation.
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 ICERaround US$ 50,000 willingness-to-pay per QALY threshold range, thus offering superior cost-effectiveness potentialcompared to any other innovative therapy in this disease area.
