Background: Pemetrexed plus platinum alone is the conventional first-line therapy for locally advanced metastatic nonsquamous non-small cell lung cancer (NSCLC) without targetable genetic aberrations. The ORIENT-11 trial revealed that sintilimab + pemetrexed plus platinum could yield more survival benefits for patients with nonsquamous NSCLC. The present study aimed to assess the cost-effectiveness of sintilimab + pemetrexed plus platinum vs. that of pemetrexed plus platinum alone as the first-line therapy for patients with nonsquamous NSCLC to inform clinically rational drug use and provide a basis for medical decisionmaking.Methods: A partitioned survival model was created to evaluate the cost-effectiveness of two groups from the perspective of the healthcare system in China. The clinical data for adverse event probabilities and extrapolating long-term survival originally collected in a phase III clinical trial (ORIENT-11) were retrieved.Local public databases and literature were used to acquire data on utility and cost. The heemod package in R software was used to calculate the life years (LYs), quality-adjusted LYs (QALYs), and total costs in each group to generate the incremental cost-effectiveness ratio (ICER) in the base case and to conduct deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA).Results: Our base case analysis (BCA) revealed that sintilimab combined with pemetrexed plus platinum provided an increase of 0.86 in QALYs with an increasing cost of United State dollar (USD) $4,317.84 relative to pemetrexed plus platinum in Chinese patients with nonsquamous NSCLC who were negative for targetable genetic variations, which induced an ICER of USD $5,020.74/QALY. The ICER value was lower than the set threshold value. The results exhibited strong robustness in the sensitivity analysis. In DSA, the parameter for the overall survival (OS) curve in chemotherapy and the cost of best supportive care were the main factors that impacted the result of the ICER. The PSA indicated that sintilimab and chemotherapy combination therapy was cost-effective.Conclusions: This study suggests that the combination of sintilimab + pemetrexed plus platinum is cost-effective as a first-line therapy in Chinese patients with nonsquamous NSCLC who are negative for targetable genetic variations from the perspective of the healthcare system.

Background:The features and survival outcome large cell lung cancer(LCLC) are scarce reported due to its low incidence,as a result, the prognoses of LCLC remain unclear.The aim of this study was to describe the demographic and clinical characteristics of large cell lung cancer with a population-base database and find the prognosis factors for cancer-specific survival(CSS) of the LCLC patients.Besides,a nomogram would be developed and independently validated to predict the CSS for LCLC based on the found prognosis factors. Methods: We extracted LCLC patients information from the Surveillance, Epidemiology, and End Results(SEER) database(2005-2014) and summarized the characteristic of the extracted factors.We used the Cox proportional hazards regression to find the prognosis factors for LCLC patients and develop the nomogram based on these in a splitted train cohort from the extracted data.The validation of the developed nomogram would be performed in an independent validation cohort from the extracted data, in which the C-index and the average of the time-dependent area under the receiver operating characteristic curve(time-dependent AUC) for CSS in 1-year, 3-year and 5-year would be calculated.The calibration curves would be drawn to visualize the performance of the established nomogram. Results: In result,4936 patients with LCLC were identified from the SEER database. Nearly half of LCLC patients were diagnosis with stage IV,only approximately 20% of patients was performed surgery.The prognosis factors influence the LCLC patients included age, sex,American Joint Committee on Cancer (AJCC) stage,race,surgery, tumour size and marital status.The calculated C-index was 0.701±0.01,mean time-dependent AUC for CSS in 1-year, 3-year and 5-year was 0.88.The calibrate curve showed that the gap between the predicted and observed CSS for 1-year, 3-year and 5-year was small. Conclusions:Sex,age,race,marital status,AJCC stage, surgery and tumour size are all the independent prognostic factors for CSS of the LCLC.The established nomogram can provide more precise evaluation for the survival of LCLC patients,and help the clinicians to make individual management.