Pharmacoeconomic evaluation of three domestic PD-1 inhibitors for advanced non-small cell lung cancer
OBJECTIVE To evaluate the cost-effectiveness of camrelizumab,sintilimab and toripalimab for advanced non-small cell lung cancer(NSCLC)based upon real-world study data.METHODS From March 2019 to February 2023,149 patients with locally advanced and advanced NSCLC on camrelizumab,sintilimab and toripalimab were retrospectively reviewed at General Hospital of Southern Theater Command.Inverse probability of treatment weighting(IPTW)method was utilized for eliminating intergroup confounding factors.A partitioned survival model was established for evaluating the cost-effectiveness of three domestic PD-1 inhibitors for locally advanced and advanced NSCLC based upon progression-free survival(PFS),overall survival(OS)and the incidence of adverse reactions of three groups after IPTW.Incremental cost-effectiveness ratio was calcu-lated.RESULTS After IPTW data processing,no difference existed in mPFS(8.20 vs.14.80 vs.14.80 month)or mOS(non-attained vs.22.70 month vs.non-attained)among three groups.Adverse reactions with an incidence of＞5％and grade≥ Ⅲ for either drug included anemia,leucopenia,neutropenia and thrombocytopenia.As compared with sintilimab,camrelizumab and tori-palimab increased clinical benefit by 0.50 and 1.00 QALYs.However,additional costs for boosting the clinical benefit by 1 QALY were divided into ￥495 151.83 and ￥440 095.05.Toripalimab required an input of ￥384 563.57 for each additional QALY of benefit as compared with camrelizumab.Regardless of whether not willingness-to-pay(WTP)threshold was set at 3 folds per capita gross domestic product(￥ 257 000/QALY)or 3 folds Guangdong's per capita GDP(￥ 305 400/QALY),cam-relizumab and toripalimab were no cost-effectiveness as compared with sintilimab and toripalimab was no cost-effectiveness as compared with camrelizumab.CONCLUSION In terms of economy,sintilimab is the most cost effective followed by camreli-zumab and toripalimab.
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