Cost-effectiveness analysis of combined immunotherapy regimens for non-squamous non-small lung cancer after tyrosine kinase inhibitors resistance.
Immunotherapy combined with anti-angiogenic agents and chemotherapy has emerged as a novel therapeutic option for non-squamous non-small cell lung cancer (non-sqNSCLC) after resistance to tyrosine kinase inhibitors (TKIs). This study evaluated the efficacy, safety, and cost-effectiveness of these regimens in patients with TKI-resistant non-sqNSCLC in China.
A network meta-analysis was performed to compare the efficacy and safety of ivonescimab plus chemotherapy (Ivon-Chem), sintilimab plus bevacizumab and chemotherapy (Sint-Beva-Chem), and atezolizumab plus bevacizumab and chemotherapy (Atez-Beva-Chem). A Markov model was constructed to assess the cost-effectiveness of Ivon-Chem, Sint-Beva-Chem, Atez-Beva-Chem, and chemotherapy until the survival probability fell below 1% in any regimen. The incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) were estimated using a willingness-to-pay (WTP) threshold of $41,859. Sensitivity analyses and scenario simulations were also performed.
Ivon-Chem, Sint-Beva-Chem, and Atez-Beva-Chem improved efficacy but were associated with poorer safety profiles than chemotherapy. Compared with chemotherapy, Ivon-Chem, Sint-Beva-Chem, and Atez-Beva-Chem were not cost-effective, with ICERs of $61,882.3/QALY, $68,657.0/QALY, and $188,820.5/QALY, respectively. Moreover, the NMBs of Ivon-Chem, Sint-Beva-Chem and Atez-Beva-Chem were all negative, indicating that none of these regimens was economically acceptable. Scenario analyses indicated that, compared with chemotherapy, Ivon-Chem would become cost-effective if the price of ivonescimab were reduced by at least 47.2%. Similarly, Sint-Beva-Chem and Atez-Beva-Chem would achieve cost-effectiveness following price reductions of 59.3% for both sintilimab and bevacizumab, and 84.4% for both atezolizumab and bevacizumab, respectively.
These immunotherapy-based regimens provided significant survival benefits in patients with TKI-resistant non-sqNSCLC. However, from the perspective of the Chinese healthcare system, Ivon-Chem, Sint-Beva-Chem, and Atez-Beva-Chem were not cost-effective. Substantial price reductions would be required to improve their economic viability.
A network meta-analysis was performed to compare the efficacy and safety of ivonescimab plus chemotherapy (Ivon-Chem), sintilimab plus bevacizumab and chemotherapy (Sint-Beva-Chem), and atezolizumab plus bevacizumab and chemotherapy (Atez-Beva-Chem). A Markov model was constructed to assess the cost-effectiveness of Ivon-Chem, Sint-Beva-Chem, Atez-Beva-Chem, and chemotherapy until the survival probability fell below 1% in any regimen. The incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) were estimated using a willingness-to-pay (WTP) threshold of $41,859. Sensitivity analyses and scenario simulations were also performed.
Ivon-Chem, Sint-Beva-Chem, and Atez-Beva-Chem improved efficacy but were associated with poorer safety profiles than chemotherapy. Compared with chemotherapy, Ivon-Chem, Sint-Beva-Chem, and Atez-Beva-Chem were not cost-effective, with ICERs of $61,882.3/QALY, $68,657.0/QALY, and $188,820.5/QALY, respectively. Moreover, the NMBs of Ivon-Chem, Sint-Beva-Chem and Atez-Beva-Chem were all negative, indicating that none of these regimens was economically acceptable. Scenario analyses indicated that, compared with chemotherapy, Ivon-Chem would become cost-effective if the price of ivonescimab were reduced by at least 47.2%. Similarly, Sint-Beva-Chem and Atez-Beva-Chem would achieve cost-effectiveness following price reductions of 59.3% for both sintilimab and bevacizumab, and 84.4% for both atezolizumab and bevacizumab, respectively.
These immunotherapy-based regimens provided significant survival benefits in patients with TKI-resistant non-sqNSCLC. However, from the perspective of the Chinese healthcare system, Ivon-Chem, Sint-Beva-Chem, and Atez-Beva-Chem were not cost-effective. Substantial price reductions would be required to improve their economic viability.