OBJECTIVES: Patients with recurrent/metastatic head and neck cancer (R/M SCCHN) may be treated with sequences starting with cetuximab (Cet) regimens (EXTREME /TPEx) followed by nivolumab, or cisplatin/carboplatin + fluorouracil (CT) + pembrolizumab followed by chemotherapy and/or Cet. The sequences starting with Cet schemes represent the therapeutic alternatives with the longest overall survival (OS) published to date in R/M SCCHN. Sequences starting with EXTREME (Cet + CT)) yielded a median OS of 19.4 months, and those starting with TPEx (Cet + cisplatin + docetaxel + granulocyte colony-stimulating factor) achieved 21.9 months.

METHODS: An analysis of pharmaceutical costs associated with treatment sequences starting with EXTREME or TPEx regimens, or pembrolizumab + CT was conducted, using official list prices. Median OS and duration of treatment (DoT) were obtained from medical literature. Costs per life month gained were calculated and compared with established willingness-to-pay thresholds (WTPt) commonly used by the Spanish National Health Service (SNS). Scenario analyses using 1) discounted drug prices and 2) mean OS and DoT were conducted. Assumptions were validated by a multidisciplinary expert committee.

RESULTS: The sequences starting with EXTREME or TPEx had a total drug cost of €26,497 and €30,269, respectively. Sequence starting with pembrolizumab + CT amounts to €71,241. The cost per life month gained amounts to €1,366 (EXTREME) and €1,382 (TPEx), remaining below the WTPt (€1,667 to €2,083 per month). The scenario analyses confirmed the base case results of costs being lower than those associated with regimens starting with pembrolizumab + CT. The treatment sequences with EXTREME and with TPEx are 62.8% and 57.5% lower that pembrolizumab + CT, respectively.

CONCLUSIONS: From the treatment sequences analyzed, those starting with EXTREME or TPEx were the ones with the lowest cost. These sequences accounted for a cost per month of life gained below established WTPt in Spain.