Economic evaluation of sintilimab plus chemotherapy vs. pembrolizumab plus chemotherapy for the treatment of first-line advanced or metastatic squamous NSCLC

Abstract

Background and objectiveSintilimab has superior efficacy and safety in patients with advanced or metastatic squamous non-small cell lung cancer (NSCLC), but its cost-effectiveness in China is unclear. This study is to evaluate the cost-effectiveness of sintilimab plus chemotherapy vs. pembrolizumab plus chemotherapy for locally advanced or metastatic squamous NSCLC in China.MethodsFrom the perspective of the Chinese health system, the partitioned survival model with three health states was established in a 3-week cycle and a lifetime time horizon. The two-stage method was used to estimate the overall survival hazard ratios to avoid the bias by crossover design in ORIENT-12 and KEYNOTE-407 studies. The anchored matching adjusted indirect comparison method (MAIC) was used for indirect comparison based on the individual patient data from ORIENT-12 and the publicly published KEYNOTE-407 study due to the lack of head-to-head clinical trials. Only direct medical costs were included, and utilities were derived from the published literature in the base case analysis. Sensitivity analysis was also performed to verify the robustness of the model results. In addition, the scenario analysis where the utilities were derived from the Quality of Life Questionnaire-Core 30 (QLQ-C30) scale in the ORIENT-12 by mapping to the EuroQol-5-dimension 5-level (EQ-5D-5L) was carried out to explore the uncertainty of the results.ResultsCompared with pembrolizumab + chemotherapy, sintilimab + chemotherapy incurred a lower lifetime cost ($12,321 vs. 36,371) and yielded fewer quality-adjusted life-years (QALYs) (0.9902 vs. 1.0085), which resulted in an incremental cost-effectiveness ratio (ICER) of $1,314,208/QALY. A sintilimab strategy is a cost-effectiveness option under the WTP of 1–3 times the GDP per capita in China ($11,250/QALY~$33,749/QALY). The utility value of the post-progression, the unit cost of albumin paclitaxel, and the utility value of the progression-free state were the main drivers in the deterministic sensitivity analysis (DSA). According to the probabilistic sensitivity analysis (PSA), sintilimab + chemotherapy was 100% cost-effective when the WTP was 1–3 times China's per capita GDP. The results of the scenario analysis showed that sintilimab + chemotherapy obtained more QALYs (1.2319 vs. 1.1815) and lower costs ($12,321 vs. 36,371), which implied that sintilimab + chemotherapy may dominate the pembrolizumab + chemotherapy.ConclusionCompared with pembrolizumab + chemotherapy, sintilimab + chemotherapy is more cost-effective for first-line treatment in Chinese patients with locally advanced or metastatic squamous NSCLC.

Cost-effectiveness of sintilimab plus chemotherapy versus chemotherapy alone as first-line treatment of locally advanced or metastatic oesophageal squamous cell carcinoma

“…In these settings, clinicians and decision-makers can leverage knowledge of economics to advance policy discussions about health care costs and to take action on accessibility, affordability, and value for use of these novel immunotherapies. Although there is no cost-effectiveness analysis study of sintilimab in the treatment of OSCC, some studies have reported that sintilimab plus chemotherapy is cost-effective in the first-line therapy of locally advanced or metastatic non-small cell lung cancer (31,32). Moreover, the combination of sintilimab plus bevacizumab is also likely to be a cost-effective option compared with sorafenib as the first-line treatment of patients with unresectable hepatocellular carcinoma in China (33)(34)(35).…”

Cost-effectiveness analysis of toripalimab plus chemotherapy as the first-line treatment in patients with advanced non-small cell lung cancer (NSCLC) without EGFR or ALK driver mutations from the Chinese perspective

“…Meanwhile, another study compared the economic value of sintilimab plus chemotherapy with pembrolizumab plus chemotherapy for locally advanced or metastatic squamous NSCLC from the perspective of the Chinese health system. Owing to the price advantage, a sintilimab-based strategy was considered the optimal choice rather than the pembrolizumab-based treatment ( Chen et al, 2022 ).…”

Trends in antineoplastic drug use, cost and prescribing patterns among patients with lung cancer in nine major cities of China, 2016–2020: a retrospective observational study based on inpatient and outpatient hospital data

“…16 44 Pembrolizumab showed good efficacy and safety for patients with advanced NSCLC; however, it was rarely used and not a cost-effective option in China due to its high price. 45 Although the cost of sintilimab was much lower than pembrolizumab, the prescriptions were also less as it was not included in clinical guidelines for lung cancer during the study period. 44 Several limitations of this study need to be acknowledged.…”

“…Bevacizumab, ranked 14th in all antineoplastic drug prescriptions, was available for lung cancer treatment and added to the medical insurance list in China in 2017 16 44. Pembrolizumab showed good efficacy and safety for patients with advanced NSCLC; however, it was rarely used and not a cost-effective option in China due to its high price 45. Although the cost of sintilimab was much lower than pembrolizumab, the prescriptions were also less as it was not included in clinical guidelines for lung cancer during the study period 44…”