A cost-effectiveness analysis of first-line toripalimab plus chemotherapy in advanced nonsquamous non-small cell lung cancer in China

This study compares first-line toripalimab with chemotherapy for advanced nonsquamous non-small cell lung cancer (NSCLC) from the perspective of the Chinese healthcare system. A three-state Markov model was established to compare the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER) of first-line toripalimab plus chemotherapy versus chemotherapy. Clinical outcomes data were acquired from the CHOICE-01 clinical trials. Costs and utilities were gathered from regional databases or published publications. One-way sensitivity and probability sensitivity analyses were used to investigate the stability of the model parameters. First-line toripalimab treatment for advanced nonsquamous NSCLC resulted in an incremental cost of $16,214.03 and added 0.77 QALYs compared to chemotherapy, which had an ICER of $21,057.18 per QALY gained. The ICER was substantially lower than the willingness to pay (WTP) threshold in China, which was $37,663.26 per QALY. The toripalimab cycle used was shown to have the greatest impact on the ICERs, according to sensitivity analysis, although none of the factors significantly affected the model’s outcomes Toripalimab plus chemotherapy is likely to be a cost-effective option compared with chemotherapy alone for patients with advanced nonsquamous NSCLC from the perspective of the Chinese healthcare system.

本研究从中国医疗卫生系统视角出发，对比一线特瑞普利单抗（toripalimab）联合化疗与单纯化疗治疗晚期非鳞状非小细胞肺癌（non-small cell lung cancer, NSCLC）的成本效果。本研究构建三状态马尔可夫（Markov）模型，以比较两种方案的质量调整生命年（quality-adjusted life years, QALYs）及增量成本效果比（incremental cost-effectiveness ratio, ICER）。临床结局数据取自CHOICE-01临床试验，成本与效用值数据则来源于区域数据库或已发表文献。本研究采用单因素敏感性分析与概率敏感性分析，考察模型参数的稳定性。相较于单纯化疗，晚期非鳞状非小细胞肺癌患者接受一线特瑞普利单抗治疗的增量成本为16214.03美元，额外获得0.77个质量调整生命年，对应的增量成本效果比为21057.18美元/每质量调整生命年。该增量成本效果比显著低于中国的支付意愿（willingness to pay, WTP）阈值37663.26美元/每质量调整生命年。敏感性分析结果显示，特瑞普利单抗的给药周期对增量成本效果比的影响最大，但所有因素均未对模型结果产生显著影响。综上，从中国医疗卫生系统视角出发，对于晚期非鳞状非小细胞肺癌患者而言，特瑞普利单抗联合化疗相较于单纯化疗，大概率是一项具备成本效果优势的治疗选择。