Journal: Scientific reports
This study evaluated the cost-effectiveness of first-line immunotherapy versus chemotherapy for patients with MSI‑H/dMMR advanced colorectal cancer in the U.S. healthcare setting.
Using individual patient data reconstructed from KEYNOTE‑177 and CheckMate‑8HW, the authors built a Markov model over a 30‑year horizon with three health states to compare:
- Dual immunotherapy: nivolumab + ipilimumab
- Single-agent immunotherapy: pembrolizumab
- Chemotherapy
Key findings (U.S. willingness-to-pay threshold: $100,000 per QALY):
- Nivolumab + ipilimumab:
- Total cost: $482,416
- Effectiveness: 18.72 QALYs
- Compared with chemotherapy: +$145,800, +5.30 QALYs
- ICER vs chemotherapy: $13,670/QALY
- INHB vs chemotherapy: 2.52 QALYs
- Pembrolizumab:
- Total cost: $336,617
- Effectiveness: 12.21 QALYs
- Compared with chemotherapy: lower cost and higher effectiveness (dominant; reflected by negative ICER of –$14,768/QALY)
- INHB vs chemotherapy: 6.80 QALYs
- Dual vs single-agent immunotherapy:
- Nivolumab + ipilimumab vs pembrolizumab: ICER $22,386/QALY; INHB 3.84 QALYs
Sensitivity analyses indicated model stability.
Conclusion: For MSI‑H/dMMR advanced colorectal cancer in the U.S., first-line immunotherapy is cost-effective compared with chemotherapy. Among the immunotherapy options studied, nivolumab plus ipilimumab appears economically preferable at conventional U.S. willingness-to-pay thresholds.