# Cost-effectiveness of chemotherapy in advanced and recurrent endometrial cancer

## TL;DR

The study reviews the cost-effectiveness of immunotherapy and chemotherapy for advanced endometrial cancer, finding that it is most cost-effective for dMMR tumors but less so for pMMR due to high drug costs.

## Contribution

The paper provides a systematic review of recent cost-effectiveness studies on immunotherapy combinations in endometrial cancer, highlighting biomarker-based selection as a potential value improvement.

## Key findings

- Pembrolizumab or dostarlimab plus chemotherapy is cost-effective for dMMR tumors at $41,000–$60,000/QALY.
- In pMMR disease, ICI combinations have higher ICERs ($90,000–$176,000/QALY), often exceeding cost-effectiveness thresholds.
- Biomarker-based patient selection may improve the economic value of immunotherapy in clinical practice.

## Abstract

•Cost-effectiveness of immune checkpoint inhibitors for advanced endometrial cancer is reviewed.•Pembrolizumab or dostarlimab plus chemotherapy is cost-effective for dMMR tumors.•Cost-effectiveness in pMMR disease is limited due to modest survival gains and high drug costs.•Use of ICIs in second-line settings requires price reductions to be economically viable.•Biomarker-based patient selection may improve value of immunotherapy in clinical practice.

Cost-effectiveness of immune checkpoint inhibitors for advanced endometrial cancer is reviewed.

Pembrolizumab or dostarlimab plus chemotherapy is cost-effective for dMMR tumors.

Cost-effectiveness in pMMR disease is limited due to modest survival gains and high drug costs.

Use of ICIs in second-line settings requires price reductions to be economically viable.

Biomarker-based patient selection may improve value of immunotherapy in clinical practice.

To review the cost-effectiveness of chemotherapy and immunotherapy-based regimens for advanced and recurrent endometrial cancer, focusing on incremental cost-effectiveness ratios (ICERs).

We conducted a literature review of peer-reviewed studies (2021–2025) evaluating immune checkpoint inhibitors (ICIs) combined with chemotherapy or targeted agents versus standard chemotherapy in advanced/recurrent endometrial cancer. Key outcomes (cost per QALY or life-year gained, willingness-to-pay [WTP] thresholds) and conclusions were extracted from nine studies.

Adding ICIs to first-line chemotherapy improved survival, especially in mismatch repair-deficient (dMMR) tumors. In dMMR disease, pembrolizumab or dostarlimab plus chemotherapy yielded ICERs of $41,000–$60,000/QALY, considered cost-effective at a $150,000/QALY threshold, but not at $100,000/QALY without price reductions. In mismatch repair-proficient (pMMR) patients, first-line ICI combinations showed smaller QALY gains and higher ICERs ($90,000–$176,000/QALY), often exceeding accepted thresholds. The durvalumab + olaparib combination was not cost-effective in any subgroup (ICERs >$200,000/QALY). In recurrent pMMR disease, pembrolizumab + lenvatinib was not cost-effective in U.S. or Chinese settings unless drug costs declined by 8–50 %. In recurrent dMMR cancer, dostarlimab improved outcomes but had an ICER of $332,000/QALY, making it economically unjustified at current prices.

ICIs offer clinical benefit in advanced endometrial cancer, particularly in dMMR tumors. First-line ICI + chemotherapy appears cost-effective for dMMR at U.S. WTP levels. However, use in pMMR or second-line settings may require drug price reductions or biomarker-based selection to be economically viable.