---
title: "Emiltatug ledadotin (Emi-Le) in Adenoid cystic carcinoma with solid histology or high-grade transformation: cost-effectiveness analyses and utility weights"
description: "Published cost-effectiveness analyses and health-state utility weights for Emiltatug ledadotin (Emi-Le, XMT-1660) in Adenoid cystic carcinoma with solid histology or high-grade transformation, each value quoted from the article: 8 cost-effectiveness analyses and 6 studies reporting utility weights. Analyses: Lenvatinib, sorafenib, and placebo in radioiodine-refractory differentiated thyroid cancer, United States: Wilson et al. (2017); Apatinib and cabozantinib versus placebo in radioiodine-refractory differentiated thyroid cancer, China: Shi et al. (2022); Avelumab plus axitinib versus sunitinib in first-line advanced renal cell carcinoma, United States: Lu et al. (2020); Tisotumab vedotin versus investigator's choice of chemotherapy in second- or third-line recurrent or metastatic cervical cancer, United States: Huo et al. (2024); 4 further articles. Utility weights: Utility weights for initiation and continuation of lenvatinib and sorafenib and disease progression, radioiodine-refractory differentiated thyroid cancer: Wilson et al. (2017); Utility weights for progression-free and progressed disease and severe adverse events, radioiodine-refractory differentiated thyroid cancer: Shi et al. (2022); Utility weights for progression-free and progressed disease, severe adverse events, and time before death, recurrent or metastatic head and neck squamous cell carcinoma: Borse et al. (2022); Utility weights for progression-free and progressed disease and adverse events of nivolumab and investigator's choice, recurrent or metastatic squamous cell carcinoma of the head and neck: Haddad et al. (2020); 2 further articles. Every value is a verbatim quote from the primary article it is shown with."
canonical: "https://www.evicenter.com/drugs/emiltatug-ledadotin--adenoid-cystic-carcinoma-with-solid-histology-or-high-grade-transformation/cost-effectiveness-analyses"
published: "2026-10-22T07:49:06-04:00"
modified: "2026-10-22T07:49:06-04:00"
---
# Emiltatug ledadotin (Emi-Le) in Adenoid cystic carcinoma with solid histology or high-grade transformation: cost-effectiveness analyses and utility weights
Published cost-effectiveness analyses and health-state utility weights that a model of this product could cite, adapt, or compare against, grouped by how each article relates to the product and its indication. Every value is quoted from the article it cites, and section 3 lists the searches that found the articles.
## Overview
| Item | Detail |
| --- | --- |
| Literature searched | Tufts Medical Center Cost-Effectiveness Analysis Registry, searched October 21, 2026; the queries are listed in section 3. |
| Cost-effectiveness analyses | 8 |
| Studies reporting utility weights | 6 |
## 1 Cost-effectiveness analyses
### 1.1 Analyses of Emiltatug ledadotin (Emi-Le and XMT-1660)
No evidence found.
### 1.2 Treatments for the same indication
No evidence found.
### 1.3 The same disease in other populations or settings
No evidence found.
### 1.4 Related diseases and analogous treatments
#### Lenvatinib, sorafenib, and placebo in radioiodine-refractory differentiated thyroid cancer, United States: Wilson et al. (2017)
Relevance: Evaluates lenvatinib and sorafenib, multitargeted VEGFR tyrosine kinase inhibitors whose trials in recurrent or metastatic ACC section 2 summarizes, against placebo in radioiodine-refractory differentiated thyroid cancer in the United States.
> “This study compared the cost-effectiveness of the two treatments with placebo from a limited societal perspective.”
> “A Markov model was developed to estimate the costs and health benefits for treatment of RR-DTC.”
> “A bimonthly cycle length and half-cycle correction were used for a lifetime time horizon.”
> “All costs were adjusted to US$2015, discounted at 3% annually.”
> “In the base case, lenvatinib was the most cost-effective treatment compared to sorafenib (incremental cost-effectiveness ratio [ICER] = $25,275/quality-adjusted life year [QALY]) and placebo (ICER = $40,869).”
> “Sorafenib is also cost-effective compared to placebo (ICER = $64,067/QALY).”
> “The acceptability curve showed lenvatinib optimal 80% of time at WTP of $100,000/QALY.”
Source: [Wilson et al. (2017)](https://pubmed.ncbi.nlm.nih.gov/28486081/)
#### Apatinib and cabozantinib versus placebo in radioiodine-refractory differentiated thyroid cancer, China: Shi et al. (2022)
Relevance: Evaluates apatinib (rivoceranib), a VEGFR tyrosine kinase inhibitor whose phase II trials in recurrent or metastatic ACC are summarized in section 2, and cabozantinib against placebo in radioiodine-refractory differentiated thyroid cancer in China.
> “We built two partitioned survival (PS) models with TreeAge Pro 2020 (TreeAge, Williamstown, MA) to compare costs and clinical outcomes associated with apatinib or cabozantinib vs. placebo for the treatment of RAIR-DTC.”
> “The time horizon was 10 years in which 95% of patients would be dead in both treatment arms.”
> “This study was conducted from the Chinese healthcare system perspective.”
> “A 5% discount rate per year was applied for both cost and effectiveness according to the China Guidelines for Pharmacoeconomic Evaluation”
> “when compared with placebo, apatinib had an additional cost of ¥44,077 with an additional QALY of 0.44 and the ICER was ¥93,460 (US dollar $13,545) per QALY.”
> “Cabozantinib yielded an additional 0.79 QALY at an additional cost of ¥3,55,614 when compared with placebo. The ICER was ¥4,52,325 ($65,554)/QALY.”
> “At the WTP threshold of ¥2,17,341/QALY, apatinib had a 100% of probability being cost-effective when compared with the placebo”
> “However, when compared cabozantinib with placebo, the probability of being cost-effective was 0”
Source: [Shi et al. (2022)](https://pmc.ncbi.nlm.nih.gov/articles/PMC9280160/)
#### Avelumab plus axitinib versus sunitinib in first-line advanced renal cell carcinoma, United States: Lu et al. (2020)
Relevance: Evaluates axitinib plus avelumab, a combination that section 2 lists among the NCCN category 2B options for recurrent or metastatic ACC, against sunitinib in advanced renal cell carcinoma in the United States.
> “we conducted this study to evaluate the cost-effectiveness of avelumab plus axitinib versus sunitinib in the first-line treatment for advanced RCC from the perspective of the US payer.”
> “We developed a Markov model using TreeAge Pro 2018 (TreeAge, Williamstown, Massachusetts).”
> “Each model cycle represented 6 weeks, and the time horizon was 10 years”
> “We discounted all costs and health outcomes at a 3% annual rate for the inflation adjustment and all costs were inflated to 2019 US dollars by the US consumer price index”
> “The ICER of avelumab plus axitinib compared with sunitinib was $565,232 per QALY”
> “The results of probabilistic sensitivity analyses demonstrated that the probability of avelumab plus axitinib being cost-effective compared with sunitinib is 2% at a willingness-to-pay threshold of $150,000 per QALY”
> “When avelumab was at 30% of the full price or axitinib was at 40% of the full price, the ICER was $86,929, $137,605, respectively”
Source: [Lu et al. (2020)](https://pmc.ncbi.nlm.nih.gov/articles/PMC7225300/)
#### Tisotumab vedotin versus investigator's choice of chemotherapy in second- or third-line recurrent or metastatic cervical cancer, United States: Huo et al. (2024)
Relevance: Evaluates tisotumab vedotin, an antibody-drug conjugate with an auristatin payload, against investigator's choice of chemotherapy as second- or third-line treatment of cervical cancer in the United States from a health care payer perspective.
> “The model framework encompasses three distinct health states that are mutually exclusive: PFS, progressive disease (PD), and death”
> “Every three weeks constituted a model cycle, and model horizon was set as a lifetime.”
> “The computational framework employed half-cycle correction and incorporated a 3% annual discount rate to estimate the cost estimation and life expectancy projection”
> “The evaluation of costs was carried out from the perspective of American third-party public healthcare payers.”
> “As a result, tisotumab vedotin gained an increase by 0.25 QALYs at an extra cost of $206,779 compared to chemotherapy. This led to an ICER of $839,107.88/QALY, exceeding the pre-set WTP threshold of $150,000 per QALY”
> “the probability sensitivity analysis reveals a 0% chance for tisotumab vedotin to be deemed cost-effective for patients using a WTP threshold of $150,000 per QALY”
Source: [Huo et al. (2024)](https://pmc.ncbi.nlm.nih.gov/articles/PMC11390250/)
#### Mirvetuximab soravtansine versus investigator's choice of chemotherapy in platinum-resistant ovarian cancer with high folate receptor-alpha expression, United States: Zhu et al. (2024)
Relevance: Evaluates mirvetuximab soravtansine, an antibody-drug conjugate used in a population selected by target antigen expression, against investigator's choice of chemotherapy in platinum-resistant ovarian cancer with high folate receptor-alpha expression in the United States from a health care sector perspective.
> “the TreeAge Pro program (version 2021) was used to develop a Markov model with three mutually exclusive health states (PFS, PD, and death) to simulate the disease course in FRα-high PROC patients.”
> “This model terminates at a lifetime horizon of ~20 years, after which all patients were expected to be deceased.”
> “Each model cycle was 1 year in length, and an annual discounting rate of 3% was applied to costs and survival simulations for all treatment regimens”
> “As this study was conducted from the perspective of the healthcare sector, only the following direct estimated costs were taken into consideration”
> “In the overall patients, the incremental cost and LYs of MIRV were $538,251 and 1.55 LYs (18.60 months) compared to IC, respectively, with an incremental QALYs of 0.90 when QoL was included”
> “In the bevacizumab-naïve patients, the incremental cost and LYs of MIRV were $575,674 and 1.88 LYs (22.56 months) compared to IC, respectively, with an incremental QALYs of 1.09 if QoL was taken into account”
> “In the bevacizumab-pretreated patients, the incremental cost and LYs of MIRV were $188,248 and 0.79 LYs (9.48 months) compared to IC, respectively, with an incremental QALYs of 0.53 if QoL was calculated.”
> “The corresponding ICERs were $596,189/QALY, $530,061/QALY, and $1,011,310/QALY, respectively”
Source: [Zhu et al. (2024)](https://pmc.ncbi.nlm.nih.gov/articles/PMC11543259/)
#### Stereotactic body radiotherapy with or without cetuximab, reirradiation with chemotherapy, and chemotherapy with or without cetuximab in locoregionally recurrent previously irradiated head and neck cancer, United States: Kim et al. (2018)
Relevance: Evaluates stereotactic body radiotherapy with or without cetuximab, reirradiation with chemotherapy, and chemotherapy with cetuximab for locoregionally recurrent, previously irradiated head and neck cancer in the United States, which parallels the radiotherapy and systemic options for recurrent disease described in section 2.
> “A Markov model was developed with 5 salvage treatment strategies: (1) platinum-based chemotherapy alone; (2) chemotherapy plus cetuximab; (3) stereotactic body radiotherapy (SBRT) alone; (4) SBRT plus cetuximab; and (5) intensity-modulated radiotherapy (IMRT) plus chemotherapy.”
> “Cohorts were followed for 3 years and the Markov cycle length was 1 month.”
> “Both costs and utilities were discounted at an annual rate of 3%.”
> “The present analysis is based on a payer’s perspective for the healthcare services (direct medical costs), with a willingness-to-pay (WTP) threshold of $100 000/QALY gained.”
> “The common base line therapy was chemotherapy alone (the least costly and the least effective). No treatment strategy was cost-effective at the WTP threshold of $100 000/QALY gained. The most cost-effective therapy was SBRT alone with an ICER of $150 866 per QALY gained. The second most effective one was SBRT plus cetuximab with an ICER of $219 509 per QALY gained. In addition, IMRT plus chemotherapy was absolutely dominated (ie, less effective and more costly than SBRT alone and SBRT plus cetuximab). Chemotherapy plus cetuximab (current standard of care) was the least cost-effective therapy among all other therapies.”
> “Probabilistic sensitivity analysis demonstrated that chemotherapy alone was favored in 65% of model iterations and 16%, 15%, 6%, and 0.5% of model iterations for SBRT alone, IMRT plus chemotherapy, SBRT plus cetuximab, and chemotherapy plus cetuximab, respectively, at the $100 000/QALY gained threshold”
Source: [Kim et al. (2018)](https://pmc.ncbi.nlm.nih.gov/articles/PMC7409550/)
#### Nivolumab versus investigator's choice of methotrexate, docetaxel, or cetuximab in recurrent or metastatic squamous cell carcinoma of the head and neck, United States: Haddad et al. (2020)
Relevance: Evaluates nivolumab against investigator's choice of methotrexate, docetaxel, or cetuximab in recurrent or metastatic squamous cell carcinoma of the head and neck in the United States; section 2 lists immune checkpoint inhibitors among investigational therapies for ACC.
> “To assess the cost-effectiveness of nivolumab monotherapy for recurrent/metastatic (R/M) squamous cell carcinoma of the head and neck (SCCHN) in the US”
> “We constructed a cohort-based partitioned survival model for three health states (progression-free, progressed disease, and death).”
> “Using overall survival and progression-free survival data from the nivolumab and investigator's choice (IC) arms of the CheckMate 141 study, the proportion of patients in each health state was estimated by parametric modeling over a 25-year period.”
> “Total costs incurred were higher with nivolumab ($101,552) than with IC ($38,067).”
> “Nivolumab was associated with a higher number of life-years (LY; 1.21) and quality-adjusted life-years (QALYs; 0.89), compared with IC (0.68 and 0.42, respectively).”
> “The incremental cost-effectiveness ratio for nivolumab compared with IC was $134,438 per QALY, and this remained qualitatively similar when increased uptake of subsequent immunotherapies was assumed ($129,603 per QALY).”
Source: [Haddad et al. (2020)](https://pubmed.ncbi.nlm.nih.gov/31928375/)
#### First-line pembrolizumab with or without chemotherapy versus cetuximab-based and cisplatin-based regimens in recurrent or metastatic head and neck squamous cell carcinoma, United States: Borse et al. (2022)
Relevance: Evaluates first-line pembrolizumab with or without chemotherapy against cetuximab-based and cisplatin-based regimens in recurrent or metastatic head and neck squamous cell carcinoma in the United States from a health care payer perspective.
> “Using public drug prices, from a US payer perspective, we evaluated the cost-effectiveness of each pembrolizumab regimen vs. cetuximab + platinum+5-FU (EXTREME regimen, trial comparator), cisplatin + docetaxel + cetuximab (TPEx regimen), cisplatin + paclitaxel, and platinum+5-FU.”
> “A three-state partitioned-survival model was used to project costs and outcomes over 20 years with 3% annual discounting.”
> “In the CPS ≥1 R/M HNSCC population, pembrolizumab monotherapy was dominant vs. EXTREME and TPEx regimens, and cost-effective (at $100,000/QALY threshold) vs. platinum+5-FU ($86,827/QALY) and cisplatin + paclitaxel ($81,473/QALY).”
> “Pembrolizumab combination therapy in the overall R/M HNSCC population was dominant vs. TPEx regimen, and cost-effective vs. EXTREME regimen ($1769/QALY), platinum+5-FU ($81,989/QALY), and cisplatin + paclitaxel ($89,505/QALY).”
> “Sensitivity analyses showed a high cost-effectiveness probability for pembrolizumab at the $100,000/QALY threshold.”
Source: [Borse et al. (2022)](https://pubmed.ncbi.nlm.nih.gov/35765888/)
## 2 Utility weights
### 2.1 Utility weights from analyses of Emiltatug ledadotin (Emi-Le and XMT-1660)
No evidence found.
### 2.2 Utility weights for the same indication
No evidence found.
### 2.3 Utility weights for the same disease in other populations or settings
No evidence found.
### 2.4 Utility weights for related diseases and analogous treatments
#### Utility weights for initiation and continuation of lenvatinib and sorafenib and disease progression, radioiodine-refractory differentiated thyroid cancer: Wilson et al. (2017)
Relevance: Utilities for initiation and continuation of lenvatinib and sorafenib and for disease progression in radioiodine-refractory differentiated thyroid cancer, which correspond to VEGFR tyrosine kinase inhibitor treatment states in recurrent or metastatic ACC.
Access: Not open access
Not quoted: The utility weights are reported in the full text, which is closed access.
> “Medical costs and utility data were obtained from RedBook, Healthcare Cost and Utilization Project, and the published literature.”
Source: [Wilson et al. (2017)](https://pubmed.ncbi.nlm.nih.gov/28486081/)
#### Utility weights for progression-free and progressed disease and severe adverse events, radioiodine-refractory differentiated thyroid cancer: Shi et al. (2022)
Relevance: Utilities for progression-free and progressed radioiodine-refractory differentiated thyroid cancer and a disutility for severe adverse events of VEGFR tyrosine kinase inhibitor treatment.
> “Since the quality-of-life data was not reported by the REALITY nor COSMIC-311 trial, we assigned a value of 0.8 for PFD and 0.5 for PD according to the study by Fordham et al. (2015) in which the health state utility valuation in RAIR-DTC was elicited.”
> “Patients with severe adverse events were assumed to have a disutility of 0.25 and all these events were assumed to incur in the first cycle for the convenience of calculation.”
Source: [Shi et al. (2022)](https://pmc.ncbi.nlm.nih.gov/articles/PMC9280160/)
#### Utility weights for progression-free and progressed disease, severe adverse events, and time before death, recurrent or metastatic head and neck squamous cell carcinoma: Borse et al. (2022)
Relevance: EQ-5D utilities for progression-free and progressed recurrent or metastatic head and neck squamous cell carcinoma, with disutilities for severe adverse events and for the months before death.
Access: Free full text
Not quoted: The utility weights are reported in Table 2 and Supplemental Table S6, which the publisher's article page loads only on request and the quote checker does not read.
> “Utilities were derived from the KEYNOTE-048 Euro-QoL five-dimension data and using a US algorithm.”
Source: [Borse et al. (2022)](https://pubmed.ncbi.nlm.nih.gov/35765888/)
#### Utility weights for progression-free and progressed disease and adverse events of nivolumab and investigator's choice, recurrent or metastatic squamous cell carcinoma of the head and neck: Haddad et al. (2020)
Relevance: Utilities for progression-free and progressed recurrent or metastatic squamous cell carcinoma of the head and neck and for adverse events of nivolumab and of investigator's choice of methotrexate, docetaxel, or cetuximab.
Access: Free full text
Not quoted: The utility weights are reported in Supplementary Tables 2 and 3 of the full text, which this page does not quote.
> “Cost, utility, adverse event, and disease management data inputs were obtained from relevant literature and applied to patients in each health state.”
Source: [Haddad et al. (2020)](https://pubmed.ncbi.nlm.nih.gov/31928375/)
#### Utility weights for treatment, progression-free, and progressed states and chemotherapy toxicities, recurrent head and neck cancer: Kim et al. (2018)
Relevance: Utilities for treatment, progression-free, and progressed states in recurrent head and neck cancer and for chemotherapy toxicities, taken from published sources.
> “Quality of life utility values for each health state were acquired through the Cost-Effectiveness Analysis registry and literature search”
> “Quality of life utility values of no disease progression state for reirradiation was assumed to be the same as chemotherapy owing to the scarcity of data”
Source: [Kim et al. (2018)](https://pmc.ncbi.nlm.nih.gov/articles/PMC7409550/)
| Health state | Utility |
| --- | --- |
| “Treatment” | “0.6” |
| “Progression free” | “0.7” |
| “Disease progression” | “0.5” |
| “Nausea/vomiting (anorexia)”, “Infection/febrile neutropenia”, “Respiratory symptom/dyspnea” | “0.35” |
| “Mucositis/dysphagia/fistula” | “0.1” |
| “Gastrointestinal complication” | “0.5” |
Source: [Kim et al. (2018)](https://pmc.ncbi.nlm.nih.gov/articles/PMC7409550/)
#### Utility weights for progression-free and progressed disease and disutilities for adverse events, platinum-resistant ovarian cancer: Zhu et al. (2024)
Relevance: Disutilities for anemia, neutropenia, nausea, and thrombocytopenia used in a model of an antibody-drug conjugate in platinum-resistant ovarian cancer.
> “Instead, average utility values of 0.75 and 0.50 were assigned to PFS and PD, respectively, as in a prior report”
> “Grade 3 or higher adverse events (AEs) affecting > 5% of patients were assigned a disutility value to correct the average utility value of PFS”
Source: [Zhu et al. (2024)](https://pmc.ncbi.nlm.nih.gov/articles/PMC11543259/)
| Health state | Utility |
| --- | --- |
| “Disutility of anemia” | “0.073 (0.058–0.088)” |
| “Disutility of neutropenia” | “0.090 (0.072–0.108)” |
| “Disutility of nausea” | “0.048 (0.038–0.058)” |
| “Disutility of thrombocytopenia” | “0.020 (0.016–0.024)” |
Source: [Zhu et al. (2024)](https://pmc.ncbi.nlm.nih.gov/articles/PMC11543259/)
## 3 Search strategy
| Dataset | Query | Results |
| --- | --- | --- |
| Ratios | emiltatug OR "XMT-1660" OR "Emi-Le" | 0 |
| Ratios | "adenoid cystic" | 0 |
| Weights | "adenoid cystic" | 0 |
| Ratios | "salivary gland" | 1 |
| Ratios | "head and neck" AND (recurrent OR metastatic) | 68 |
| Ratios | "carbon ion" OR "particle therapy" | 2 |
| Ratios | lenvatinib AND thyroid | 4 |
| Ratios | axitinib OR sorafenib | 275 |
| Ratios | "tisotumab vedotin" OR "mirvetuximab" OR "antibody-drug conjugate" | 10 |
| Weights | "salivary" OR "parotid" OR "xerostomia" | 41 |
| Methods | "adenoid cystic" OR "salivary gland cancer" OR "salivary gland carcinoma" | 0 |
| Methods | "B7-H4" OR "Dolasynthen" OR "auristatin" | 0 |
| Weights | "head and neck" AND (progression OR progressed OR "progression-free") | 87 |
| Ratios | metastasectomy | 7 |
| Ratios | apatinib OR rivoceranib | 32 |
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