Effectiveness and cost-effectiveness analysis of 11 treatment paths, seven first-line and three second-line treatments for Chinese patients with advanced wild-type squamous non-small cell lung cancer: A sequential model

Abstract

BackgroundA total of 11 treatment sequences for advanced wild-type squamous non-small cell lung cancer are recommended by Chinese Society of Clinical Oncology Guidelines, consisting of seven first-line and three second-line treatments. Five of these treatments were newly approved in China between 2021 and 2022. We evaluated the effectiveness and cost-effectiveness of these strategies from the Chinese healthcare system perspective.MethodsNetwork meta-analysis with non-proportional hazards was used to calculate the relative efficacy between interventions. A sequential model was developed to estimate costs and quality-adjusted life years (QALY) for treatment sequences with first-line platinum- and paclitaxel-based chemotherapy (SC) with or without nedaplatin, tislelizumab, camrelizumab, sintilimab, sugemalimab or pembrolizumab, followed by second-line docetaxel, tislelizumab or nivolumab. SC and docetaxel were used as comparators for first-line and second-line treatments, respectively. QALY and incremental cost-effectiveness ratio (ICER) were used to evaluate effectiveness and cost-effectiveness, respectively. Cost-effective threshold was set as USD 19,091. Subgroup analysis was conducted to determine the best first-line and second-line therapy.ResultsPembrolizumab + SC, followed by docetaxel (PED) was the most effective treatment sequence. QALYs for patients received SC, nedaplatin + SC, tislelizumab + SC, sintilimab + SC, camrelizumab + SC, sugemalimab + SC, pembrolizumab + SC followed by docetaxel were 0.866, 0.906, 1.179, 1.266, 1.179, 1.266, 1.603, 1.721, 1.807; QALYs for SC, nedaplatin + SC followed by tislelizumab were 1.283, 1.301; QALYs for SC, nedaplatin + SC followed by nivolumab were 1.353, 1.389. Camrelizumab + SC, followed by docetaxel (CAD) was the most cost-effective. Compared to SC with or without nedaplatin, tislelizumab, or sintilimab followed by docetaxel, ICERs of CAD were USD 12,276, 13,210, 6,974, 9,421/QALY, respectively. Compared with nedaplatin or SC followed by tislelizumab, the ICERs of CAD were USD 4,183, 2,804/QALY; CAD was dominant compared with nedaplatin or SC followed by nivolumab; The ICER of sugemalimab + SC followed by docetaxel and PED were USD 522,023, 481,639/QALY compared with CAD. Pembrolizumab + SC and camrelizumab + SC were the most effective and cost-effective first-line options, respectively; tislelizumab was the most effective and cost-effective second-line therapy. Tislelizumab used in second-line was more effective than first-line, no significant differences between their cost-effectiveness. Sensitivity and scenario analysis confirmed robustness of the results.ConclusionsPED and CAD are the most effective and cost-effective treatment sequence, respectively; pembrolizumab + SC and camrelizumab + SC are the most effective and cost-effective first-line choice, respectively; tislelizumab is the most effective and cost-effective second-line choice.

Cost-effectiveness of immunotherapies for advanced squamous non-small cell lung cancer: a systematic review

“…However, compared to imported drugs, Chinese ontologic developed inhibitors such as camrelizumab, sintilimab and toripalimab achieve greater accessibility and cost-effectiveness at a lower price while balancing efficacy [ 56 ]. The study included in this review by Zhao et al (2023) also confirmed the cost-effectiveness of camrelizumab in combination with chemotherapy in the treatment of patients with metastatic LSCC [ 55 ]. Similarly, although the amount of supporting evidence is limited, Chen 2022 [ 44 ] also showed that it is not pembrolizumab + chemotherapy that is more cost-effective for Chinese payers, but the locally developed regimen of sintilimab + chemotherapy [ 44 ].…”

“…With ICER below $100,000/QALY as the maximum threshold, the P + C group is cost-effective. Meanwhile, with 2.513 LYs and 1.603 QALYs, Zhao 2023 [ 55 ] demonstrated camrelizumab plus platinum and paclitaxel chemotherapy as most cost-effective first-line choice.…”

Cost-effectiveness of additional serplulimab to chemotherapy in metastatic squamous non-small cell lung cancer patients

“…The addition of camrelizumab to chemotherapy was considered cost-effective from a healthcare perspective in China for metastatic NSCLC patients (32). Zhao et al discovered that the combination of camrelizumab with paclitaxel-based chemotherapy, followed by docetaxel, within a selection of 11 treatment sequences for metastatic NSCLC patients, represented a cost-effective treatment option and tislelizumab was deemed the most effective and cost-effective second-line option (33). The combination of sintilimab and chemotherapy was proven to be more costeffective than the combination of pembrolizumab and chemotherapy for patients with metastatic NSCLC in China, as the QALYs obtained in the sintilimab group were similar to those in the pembrolizumab group, with substantially lower costs (34).…”

Cost-effectiveness analysis of the tislelizumab versus docetaxel for advanced or metastatic non-small-cell lung cancer in China

“…However, previous studies ( 10 – 14 ) have demonstrated that economic evaluations of imported PD-1/PD-L1 inhibitors, such as pembrolizumab, nivolumab, and atezolizumab, do not confer a cost-effectiveness advantage. As a domestically developed PD-1/PD-L1 inhibitor, tislelizumab offers a lower price compared to imported counterparts while maintaining comparable efficacy ( 12 ). Consequently, the CSCO guidelines advocate for tislelizumab as second-line treatment in patients with driver-negative advanced or metastatic NSCLC.…”