Cost-Effectiveness of Chemotherapy in Advanced and Recurrent Endometrial Cancer

A recent study has shed light on the cost-effectiveness of chemotherapy and immunotherapy-based regimens for advanced and recurrent endometrial cancer. Researchers from Fujinomiya City General Hospital in Shizuoka, Japan, conducted a literature review of peer-reviewed studies from 2021 to 2025 to evaluate the incremental cost-effectiveness ratios (ICERs) of combining immune checkpoint inhibitors (ICIs) with chemotherapy or targeted agents versus standard chemotherapy.

The study found that 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).

Key Takeaways:

• The study found that 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, but not in pMMR or second-line settings without drug price reductions or biomarker-based selection.
• The durvalumab + olaparib combination was not cost-effective in any subgroup (ICERs $200,000/QALY).
• In recurrent dMMR cancer, dostarlimab improved outcomes but had an ICER of $332,000/QALY, making it economically unjustified at current prices.
• The study suggests that the use of ICIs in endometrial cancer may require careful selection of patients and consideration of cost-effectiveness in different clinical settings.
• The research emphasizes the importance of biomarker-based selection and drug price reductions to improve the cost-effectiveness of ICIs in endometrial cancer.

Statistics:

• The ICER for pembrolizumab or dostarlimab plus chemotherapy in dMMR disease is $41,000-$60,000/QALY.
• The ICER for durvalumab + olaparib combination in any subgroup is $200,000/QALY.
• The ICER for dostarlimab in recurrent dMMR cancer is $332,000/QALY.
• The study found that ICIs improved survival in dMMR tumors, but had smaller QALY gains and higher ICERs in pMMR patients.

Sources:

• Cost-effectiveness of chemotherapy in advanced and recurrent endometrial cancer. Gynecologic Oncology Reports, 2025, 59():101761. (Gynecologic Oncology Reports - http://www.journals.elsevier.com/gynecologic-oncology-reports/).
• Fujinomiya City General Hospital, Department of Obstetrics and Gynecology, Fujinomiya, Shizuoka, Japan.