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Cost-Effectiveness Analysis of Cemiplimab Versus Chemotherapy as First-Line Treatment in Advanced NSCLC with PD-L1 Expression Levels of at Least 50%

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Cemiplimab may significantly increase overall survival in the first-line treatment of advanced non-small cell lung cancer (NSCLC) with a PD-L1 level of at least 50%. Therefore, there is a need to consider the cost-effectiveness of using this therapy for this indication.


This Markov model was built to estimate the cost and effectiveness of cemiplimab vs. chemotherapy in the first-line treatment of advanced NSCLC based on the data from the EMPOWER-Lung 1 trial. Life-years (LYs), quality-adjusted LYs (QALYs) and lifetime costs were estimated. One-way and probabilistic sensitivity analyses were performed to evaluate the model uncertainty. Additional subgroup analyses were performed.


Treatment of advanced NSCLC with cemiplimab added 0.546 QALYs (1.492 LYs) and resulted in an incremental cost of $22,069.804 compared with chemotherapy, which was associated with an incremental cost-effectiveness ratio of $40,390.412 per QALY gained. The results of one-way sensitivity analysis found that the cost of cemiplimab was the most sensitive factor in our study. The probabilistic sensitivity analysis showed that the probability of cemiplimab being cost-effective was 100%. The subgroup analysis demonstrated that high PD-L1 expression (≥ 90%, > 60 to < 90% and ≥ 50 to ≤ 60%) also kept the incremental cost-effectiveness stable at $63,415.2450 per QALY, $61,896.446 per QALY and $–71,921.259 per QALY.


From the perspective of US payers, cemiplimab is cost-effective in the first-line treatment of advanced NSCLC at the willingness-to-pay threshold of $150,000 per QALY.

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We thank the participants of the study. Thanks to your hard work, our research was completed. Thank you again.

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Correspondence to Chongqing Tan.

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The work was supported by grants from the National Natural Science Foundation of China (grant numbers: 82073818 and 71874209) and the Key Science-Technology Research and Development Program of Hunan Province (grant number: 2020JJ8046) and the Hunan Provincial Natural Science Foundation of China (grant number: 2019JJ40411). The Journal’s Rapid Service Fee was funded by the authors.


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.

Author Contributions

LW is the first author and has completed the entire paper; YP and SQ contributed to the model; XZ, LP, SL, and XW gave me constructive advice and guided me in writing the paper. CT was the corresponding author and gave me the concept and design of the study during writing.


Liting Wang,Ye Peng, Xiaohui Zeng, Liubao Peng, Sini Li, Shuxia Qin, Xiaomin Wan and Chongqing Tan declare no conflicts of interest.

Compliance with Ethics Guidelines

This article is based on a retrospective study and does not contain any studies with human participants or animals performed by any of the authors.

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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Wang, L., Peng, Y., Zeng, X. et al. Cost-Effectiveness Analysis of Cemiplimab Versus Chemotherapy as First-Line Treatment in Advanced NSCLC with PD-L1 Expression Levels of at Least 50%. Adv Ther 38, 4354–4365 (2021).

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