Cost-utility Analysis of PD-1/PD-L1 Inhibitor Combination Therapies as First-line Treatment for Advanced Non-small-cell Lung Cancer
OBJECTIVE To compare the cost-utility of eight programmed death 1(PD-1)/programmed cell death-ligand 1(PD-L1)inhibitor combination regimens for first-line treatment of advanced non-small cell lung cancer(NSCLC)from the perspective of Chinese healthcare system.METHODS Relevant data were derived from a published network meta-analysis and randomized controlled trails,a three-state Markov model was established to analyze the cost-utility of eight immunotherapy combinations.The robustness of results were validated through sensitivity analyses and a series of scenario analyses was also conducted.RESULTS The incremental cost-utility ratio(ICUR)of the sintilizumab plus chemotherapy group and the tislelizumab plus chemotherapy group were ￥ 125 143.88/quality adjusted life year(QALY)and ¥ 189 609.64/QALY,respectively,which were less than the willingness-to-pay(WTP)threshold of ￥ 257 094/QALY,and all the ICURs of other PD-1/PD-L1 inhibitor combination regimens exceeded the WTP threshold and were not economical.Scenario analyses found that even if the medical insurance reimbursement ratio reached 80％,the different combinations of pembrolizumab,nivolumab and atezolizumab were not economical.CONCLUSION Compared with other PD-1/PD-L1 inhibitor combination regimens,sintilizumab plus chemotherapy and tislelizumab plus chemotherapy have cost-utility advantages in the first-line treatment of advanced NSCLC,which can provide a certain reference for selecting a reasonable treatment plan for NSCLC patients.
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