OBJECTIVES: Endometrial cancer (EC) is the sixth most common gynaecologic malignancy in women, accounting for 4.5% of all cancer cases. Due to limited healthcare resources and the recent availability of new interventions for advanced or recurrent endometrial cancer (A/R EC), economic evaluations of A/R EC therapies are becoming increasingly important. This study aimed to systematically identify evidence describing the cost-effectiveness of immunotherapies alone or in combination, compared with standard of care (SoC) chemotherapy in patients with advanced stage III/IV, or first recurrent EC.

METHODS: A systematic literature review was undertaken to identify relevant articles published between 1946 and 30^th May 2024. Database searches were conducted in Embase, MEDLINE(R) ALL, and the Cochrane Library via Ovid. Secondary searches were conducted in Gynecologic Oncology, the Cost-Effectiveness Analysis registry, and Google Scholar. Studies which assessed the cost-effectiveness of immunotherapies in A/R EC were included. Two reviewers independently screened the literature, extracted data from full publications, and assessed methodological quality using the Drummond 10-item rated checklist.

RESULTS: Of the 167 articles identified, 18 cost-effectiveness analyses fulfilled the review inclusion criteria; 89% of these studies scored 8 or more points on the Drummond 10-item checklist. Most analyses considered pembrolizumab in mono or combination-therapy (n=16); others investigated bevacizumab (n=2), atezolizumab (n=1), trastuzumab (n=1), or dostarlimab (n=1). All therapies were compared to chemotherapy from a payer or societal perspective. Microsatellite stable/instable and mismatch repair proficient/deficient subgroups were identified in the United States, Sweden and China. The key drivers of cost-effectiveness were cost of treatment and utility of progressed disease.

CONCLUSIONS: Immunotherapy options for A/R EC are limited, and that their cost-effectiveness when compared to SoC is dependent on the patient subgroup, treatment cost, and the country’s willingness-to-pay threshold. Evidence-based pricing strategy is required to ensure successful outcomes for pharmaceutical companies, healthcare stakeholders, and patients alike.