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Biomarkers-Based Cost-Effectiveness of Toripalimab Plus Chemotherapy for Patients with Treatment-Naive Advanced Non-Small Cell Lung Cancer

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Abstract

Introduction

This study examined the cost-effectiveness of first-line toripalimab plus chemotherapy (TC) for patients with advanced non-small cell lung cancer (NSCLC), excluding patients with nonsquamous NSCLC and EGFR/ALK mutations. It further analyzed the cost-effectiveness of this strategy in biomarker-based subgroups, all within the context of the Chinese healthcare system.

Methods

Eighteen Markov models with 21-day Markov cycle lengths and 30-year time horizons were constructed in this study. Clinical effectiveness data were derived from the CHOICE-01 trial. Health state utilities and costs data were obtained from various sources. The primary outputs were the calculation of incremental cost-effectiveness ratios (ICERs), which were then compared to a willingness-to-pay (WTP) threshold of $17,961 per quality-adjusted life-year (QALY). This comparison was used to determine the treatment that offered greater cost-effectiveness. To account for uncertainty in the model, sensitivity analyses were conducted.

Results

For the overall patient population, the estimated ICER between first-line TC and placebo plus chemotherapy (PC) was $9445/QALY, significantly lower than the WTP threshold used in the model. In subgroups based on pathologic types, first-line TC had an ICER of $16,757/QALY for patients with nonsquamous NSCLC, slightly below the WTP threshold; first-line TC demonstrated dominance in patients with squamous NSCLC, indicating both better effectiveness and lower costs compared to first-line PC. In biomarkers-based subgroups, first-line TC was dominant over first-line PC in the subgroups with programmed cell death ligand 1 (PD-L1) expression ≥ 50% and SMARCA4 mutations. Moreover, first-line TC had ICERs lower than the WTP threshold in other subgroups, except for the subgroup with RB1 mutations. Sensitivity analysis confirmed the robustness of these findings.

Conclusion

From the perspective of the Chinese healthcare system, this study’s findings suggested that first-line TC represents a cost-effective strategy for patients with advanced NSCLC. However, the cost-effectiveness of first-line TC varied across different subgroups when considering predictive biomarkers.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Funding

This study, and the journal’s Rapid Service fee, was funded by the Science and Technology Development Program of Medical and Health of Shandong Province (No. 202102040505) and the Key research projects of Jining (No. 2021YXNS122) and the Nursery research program of Affiliated Hospital of Jining Medical University (No. MP-MS-2021-001).

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Author notes

  1. Huixian Zhang and Lanfang Li contributed equally to this work.

Authors and Affiliations

  1. Department of Clinical Pharmacy, Affiliated Hospital of Jining Medical University, Jining, China

    Huixian Zhang, Lanfang Li, Lei Feng & Xin Zhang

  2. School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    Zhen Zhou

  3. Department of Pharmacy, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China

    Qiao Liu

  4. Department of Oncology, Affiliated Hospital of Jining Medical University, Jining, China

    Jianbo Feng

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  1. Huixian Zhang
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  5. Xin Zhang
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Contributions

Qiao Liu had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Huixian Zhang and Qiao Liu: concept and design. All authors: acquisition, analysis, or interpretation of data. Huixian Zhang, Lanfang Li and Zhen Zhou: drafting of the manuscript. All authors: critical revision of the manuscript for important intellectual content. Huixian Zhang, Xin Zhang and Qiao Liu: statistical analysis.

Corresponding author

Correspondence to Qiao Liu.

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Conflict of Interest

Huixian Zhang, Lanfang Li, Lei Feng, Zhen Zhou, Xin Zhang, Jianbo Feng, Qiao Liu declare they have nothing to disclose.

Ethical Approval

The model used in this analysis was based on previously conducted studies and other economic models; no studies with human participants or animals were performed by any of the authors. Since no individual patient-level data were involved, this study was exempted from the review by the Chinese ethics review committee.

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Zhang, H., Li, L., Feng, L. et al. Biomarkers-Based Cost-Effectiveness of Toripalimab Plus Chemotherapy for Patients with Treatment-Naive Advanced Non-Small Cell Lung Cancer. Adv Ther 40, 4945–4956 (2023). https://doi.org/10.1007/s12325-023-02679-8

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  • DOI: https://doi.org/10.1007/s12325-023-02679-8

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