免疫检查点抑制剂（ICIs）作为晚期或转移性食管鳞状细胞癌（ESCC）的二线治疗在延长总生存期（OS）方面表现出优异的临床疗效，并被指南推荐。然而，哪种 ICI 最具成本效益仍不确定。本研究从中国医疗保健体系的角度评估了ICIs作为食管鳞癌二线治疗的成本效益。通过网络荟萃分析（NMA）获得风险比（HR）进行间接比较。采用 10 年时间范围的三态马尔可夫模型来评估成本效益。状态转换概率是根据临床试验的 Kaplan-Meier (KM) 曲线数据和 NMA 的 HR 计算的。公用事业和成本来自当地收费或之前发表的研究。进行单变量和概率敏感性分析（PSA）来检查模型的稳健性。结果根据总成本、质量调整生命年 (QALY) 和增量成本效益比 (ICER) 进行评估。五项临床试验（ATTRACTION-3、ESCORT、KEYNOTE-181、ORIENT-2、RATIONALE-302 ）共有 1797 名患者被纳入 NMA。 NMA 显示卡瑞利珠单抗和替雷利珠单抗在无进展生存期 (PFS) 和 OS 方面获得了相对较高的排名。与信迪利单抗相比，替雷利珠单抗和卡瑞利珠单抗治疗获得了 0.018 和 0.034 额外的 QALY，导致 ICER 增量分别为 75,472.65 美元/QALY 和 175,681.9 美元/QALY。纳武单抗和派姆单抗产生较低的 QALY 和较高的成本，表明与信迪利单抗相比，两者均占主导地位。在大多数配对比较的单变量敏感性分析中，HR 和健康状况效用是最有影响力的参数。 PSA 结果表明，在 WTP 阈值为 38,223.34 美元/QALY 时，信迪利单抗有 84.4% 的机会成为最具成本效益的治疗方案。在情景分析中，如果假设卡瑞利珠单抗的价格下降 64.6% 或假设替雷利珠单抗的价格下降 16.9%，则信迪利单抗将不再具有成本效益。 在 5 个潜在竞争 ICI 中，信迪利单抗很可能成为中国局部晚期或转移性 ESCC 最具成本效益的二线治疗方案。© 2024。作者。

Immune checkpoint inhibitors (ICIs) have demonstrated superior clinical efficacy in prolonging overall survival (OS) as the second-line treatment for advanced or metastatic esophageal squamous cell carcinoma (ESCC), and were recommended by the guidelines. However, it remains uncertain which ICI is the most cost-effective. This study assessed the cost-effectiveness of ICIs as the second-line treatment for ESCC based on the perspective of the Chinese healthcare system.A network meta-analysis (NMA) was performed to obtain the Hazard ratios (HRs) for indirect comparisons. A three-state Markov model with a 10-year time horizon was conducted to assess the cost-effectiveness. The state transition probabilities were calculated with Kaplan-Meier (KM) curves data from clinical trial and HRs from the NMA. Utilities and costs were derived from local charges or previously published studies. Univariate and probabilistic sensitivity analyses (PSA) were performed to examine model robustness. The results were assessed based on the total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs).Five clinical trials (ATTRACTION-3, ESCORT, KEYNOTE-181, ORIENT-2, RATIONALE-302) with a total of 1797 patients were included in the NMA. The NMA showed that both camrelizumab and tislelizumab received relatively high rankings for progression-free survival (PFS) and OS. Compared with sintilimab, treatment with tislelizumab and camrelizumab gained 0.018 and 0.034 additional QALYs, resulting in incremental ICERs of $75,472.65/QALY and $175,681.9/QALY, respectively. Nivolumab and pembrolizumab produced lower QALYs and greater costs, suggesting that both were dominated in comparison to sintilimab. HRs and health state utilities were the most influential parameters in most univariate sensitivity analyses of paired comparisons. PSA results suggested that sintilimab had an 84.4% chance of being the most cost-effective treatment regimen at the WTP threshold of $38,223.34/QALY. In the scenario analysis, sintilimab would no longer be cost-effective, if the price of camrelizumab was assumed to decrease by 64.6% or the price of tislelizumab was assumed to decrease by 16.9%.Among the five potential competing ICIs, sintilimab was likely to be the most cost-effective regimen as the second-line treatment for locally advanced or metastatic ESCC in China.© 2024. The Author(s).