Economic evaluation of six immune checkpoint inhibitor-based first-line therapies for advanced squamous non-small-cell lung cancer: a cost-effectiveness analysis based on network meta-analysis
Year: 2026
Type: article
Abstract: Background: Advanced squamous non-small-cell lung cancer (sq-NSCLC) imposes a substantial clinical and economic burden. Immune checkpoint inhibitors (sugemalimab, tislelizumab, penpulimab, serplulimab, camrelizumab, and pembrolizumab) combined with chemotherapy improve survival, but their comparative cost-effectiveness remains uncertain. Methods: A three-state partitioned survival model with 3-week cycles and a lifetime horizon was developed from the Chinese healthcare-system perspective. Clinical efficacy was derived from six phase 3 trials and synthesized using network meta-analysis. Costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) for each ICI-based regimen versus chemotherapy were estimated. The willingness-to-pay (WTP) threshold was set at $27,906/QALY. Deterministic, probabilistic, scenario, and full incremental analyses were performed. Results: In the base-case analysis, chemotherapy alone yielded 0.71 QALYs at $12,227.47. All ICI-based regimens increased QALYs to between 1.24 and 2.07. Pembrolizumab plus chemotherapy provided the greatest health benefit, yielding 2.07 QALYs, but had an ICER of $70,913.04 per QALY versus chemotherapy alone. Penpulimab plus chemotherapy had the lowest ICER versus chemotherapy alone ($13,064.23 per QALY), followed by camrelizumab ($13,361.50/QALY), and tislelizumab plus chemotherapy ($14,022.95/QALY), all below the WTP threshold. Sugemalimab plus chemotherapy and serplulimab plus chemotherapy exceeded the threshold. Probabilistic sensitivity analysis indicated that camrelizumab plus chemotherapy had the highest probability of being cost-effective (95%) at $27,906/QALY. In the full incremental analysis, the efficiency frontier comprised chemotherapy alone, penpulimab plus chemotherapy, camrelizumab plus chemotherapy, and pembrolizumab plus chemotherapy; camrelizumab plus chemotherapy was the preferred strategy after dominated options were excluded. Conclusion: At the selected WTP threshold, camrelizumab plus chemotherapy may be the preferred first-line strategy after strictly and extendedly dominated alternatives were excluded. This finding depends on the indirect comparisons, chemotherapy baseline, drug prices, survival extrapolation, and post-progression assumptions.
Source: Frontiers in Pharmacology
Authors: Zijian Qiu, Guodong Wang, Ying Lou, Feng Xuan
Institutions: Wenzhou Medical University, Quzhou City People's Hospital
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7221615664