Determining the optimal PD‐1/PD‐L1 inhibitors for the first‐line treatment of non‐small‐cell lung cancer with high‐level PD‐L1 expression in China

Teng, Mengmeng; Chen, Si‐Ying; Yang, Bo; Wang, Yan; Han, Ruiying; An, Meng‐Na; Dong, Yalin; You, Haisheng

doi:10.1002/cam4.4191

Cited by 10 publications

(5 citation statements)

References 36 publications

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“…The standard distribution models simulating the long-term survival of patients diagnosed with cancer have been widely applied in economic evaluations on immuno-oncology therapies. A majority of previous studies ( Liu et al, 2021 ; Teng et al, 2021 ; Kang et al, 2022 ) which undertook indirect comparison overlooked the issue of PH and performed NMA by assuming the HRs remain constant as time went by, calculating survival data in treatment groups depending on the constant HR. However, with breakthroughs in immunotherapy, the survival of cancer patients probably have changed and the hazard function is foreseenably becoming more complex.…”

Section: Discussionmentioning

confidence: 99%

Economic evaluation of five first-line PD-(L)1 inhibitors for treating non-squamous non-small cell lung cancer in China: A cost-effectiveness analysis based on network meta-analysis

2023

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Background and objective: Non-small cell lung cancer (NSCLC) is one of the most malignant cancer types that causes substantial economic burden in China. This study aimed to evaluate the cost-effectiveness of five first-line anti-PD-(L)1 treatments, including sintilimab, camrelizumab, atezolizumab, pembrolizumab and sugemalimab with each combined with chemotherapy, for treating advanced non-squamous NSCLC (nsq-NSCLC) from Chinese healthcare system perspective.Methods: Clinical data were obtained from the following clinical trials, namely, ORIENT-11, CameL, IMpower132, KEYNOTE-189 and GEMSTONE-302. A network meta-analysis was performed based on fractional polynomial models. We constructed a partitioned survival model with a three-week cycle length and a lifetime horizon to derive the incremental cost-effectiveness ratio (ICER). We performed one-way sensitivity analysis and probablistic sensitivity analysis to test the robustness. Additionally, two scenario analyses were undertaken to investigate the impact of Patient Assistant Program on the economic conclusion and to explore potential uncertainty associated with population representativeness of the global trial.Results: Compared with camrelizumab + chemotherapy, sugemalimab + chemotherapy and atezolizumab + chemotherapy were dominated, and the ICERs generated from sintilimab + chemotherapy and pembrolizumab + chemotherapy were $15,280.83/QALY and $159,784.76/QALY, respectively. Deterministic sensitivity analysis showed that uncertainty around ICERs was mainly driven by HR related parameters derived from NMA and drug price. The probablistic sensitivity analysis suggested that camrelizumab treatment was cost-effective at a willingness-to-pay threshold of 1-time GDP per capita. When the threshold was set as 3-time GDP per capita, sintilimab strategy demonstrated the excellent cost-effective advantage. Sensitivity analysis proved the reliability of base-case results. Results from two scenario analyses indicated that the primary finding was robust.Conclusion: In current context of Chinese healthcare system, sintilimab + chemotherapy appeared to be cost-effective for the treatment of nsq-NSCLC compared with sugemalimab, camrelizumab, pembrolizumab as well as atezolizumab combined with chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Economic evaluation of five first-line PD-(L)1 inhibitors for treating non-squamous non-small cell lung cancer in China: A cost-effectiveness analysis based on network meta-analysis

2023

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“…First, negotiate a lower price for the drug and put it on the Medicare list. One study showed that atezolizumab, when reduced in price by 80%, may have a cost-effective advantage at a WTP threshold of US$32 517/QALY 31. Same as serplulimab, sintilimab, a domestic PD-1, was launched in China at the end of 2019 with a price as high as US$1132.74.…”

Section: Discussionmentioning

confidence: 99%

“…One study showed that atezolizumab, when reduced in price by 80%, may have a cost-effective advantage at a WTP threshold of US$32 517/QALY. 31 Same as serplulimab, sintilimab, a domestic PD-1, was launched in China at the end of 2019 with a price as high as US$1132.74. In just 2 years, the price dropped to US$156.08, a whopping 86% drop.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis of serplulimab combined with chemotherapy in the treatment of extensive-stage small-cell lung cancer from the perspective of the healthcare system in China

Long

Liao

et al. 2023

BMJ Open

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ObjectiveThe ASTRUM-005 trial showed that serplulimab plus chemotherapy (SEP) significantly extended survival time compared with chemotherapy in the treatment of small cell lung cancer. But the survival benefits of SEP came at high costs, and its economy is not clear. Therefore, this study aimed to evaluate the cost-effectiveness of SEP from the perspective of the Chinese healthcare system.DesignA partition survival model was built to simulate the outcomes. The clinical data came from the ASTRUM-005 trial, and only direct medical costs were included in the model. The utility values referred to the published literature. Scenario analyses 1 and 2 explored outcomes in the presence of a patient assistance plan (PAP) and different simulation periods, respectively. Scenario analysis 3 compared the cost-effectiveness of atezolizumab plus chemotherapy (AEP) with SEP by network meta-analysis. Sensitivity analyses were conducted to assess the robustness of the results.Outcome measuresTotal costs, incremental costs, life years, quality-adjusted life years (QALYs), incremental QALYs and incremental cost-effectiveness ratio (ICER).ResultsCompared with chemotherapy, SEP achieved an additional 0.34 QALYs at incremental costs of US$41 682.63, with an ICER of US$122 378.86/QALY. When PAP was available, ICER was US$58 316.46/QALY. In the simulation time of 5 years and 20 years, the ICER was US$132 637.97/QALY and US$118 054.59/QALY, respectively. When compared with AEP, SEP not only reduced the costs by US$47 244.87 but also gained 0.07 QALYs more. Sensitivity analyses showed that the price of serplulimab and the utility value of the progression-free survival stage were the main influencing parameters, and the results were stable.ConclusionsCompared with chemotherapy, SEP was not cost-effective from the perspective of the Chinese healthcare system. However, SEP was absolutely dominant in comparison with AEP.

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“…Drug price information was acquired from the local bid-winning price (Drugdataexpy) ( 20 ), which is equal to the drug prices for most Chinese hospitals. Other information was sourced from the existing literature ( 14 , 15 , 27 - 33 ). Based on an assumption of a mean area of 1.72 m 2 of the patient’s body surface, we calculated the drug dosage for chemotherapy in each cycle ( 29 ).…”

Section: Methodsmentioning

confidence: 99%

Section: Costmentioning

confidence: 99%

Comparing the cost-effectiveness of sintilimab + pemetrexed plus platinum and pemetrexed plus platinum alone as a first-line therapy for Chinese patients with nonsquamous non-small cell lung cancer

Shi¹,

Di²,

Li³

et al. 2023

Transl Cancer Res

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Background: Pemetrexed plus platinum alone is the conventional first-line therapy for locally advanced metastatic nonsquamous non-small cell lung cancer (NSCLC) without targetable genetic aberrations. The ORIENT-11 trial revealed that sintilimab + pemetrexed plus platinum could yield more survival benefits for patients with nonsquamous NSCLC. The present study aimed to assess the cost-effectiveness of sintilimab + pemetrexed plus platinum vs. that of pemetrexed plus platinum alone as the first-line therapy for patients with nonsquamous NSCLC to inform clinically rational drug use and provide a basis for medical decisionmaking.Methods: A partitioned survival model was created to evaluate the cost-effectiveness of two groups from the perspective of the healthcare system in China. The clinical data for adverse event probabilities and extrapolating long-term survival originally collected in a phase III clinical trial (ORIENT-11) were retrieved.Local public databases and literature were used to acquire data on utility and cost. The heemod package in R software was used to calculate the life years (LYs), quality-adjusted LYs (QALYs), and total costs in each group to generate the incremental cost-effectiveness ratio (ICER) in the base case and to conduct deterministic sensitivity analysis (DSA) and probabilistic sensitivity analysis (PSA).Results: Our base case analysis (BCA) revealed that sintilimab combined with pemetrexed plus platinum provided an increase of 0.86 in QALYs with an increasing cost of United State dollar (USD) $4,317.84 relative to pemetrexed plus platinum in Chinese patients with nonsquamous NSCLC who were negative for targetable genetic variations, which induced an ICER of USD $5,020.74/QALY. The ICER value was lower than the set threshold value. The results exhibited strong robustness in the sensitivity analysis. In DSA, the parameter for the overall survival (OS) curve in chemotherapy and the cost of best supportive care were the main factors that impacted the result of the ICER. The PSA indicated that sintilimab and chemotherapy combination therapy was cost-effective.Conclusions: This study suggests that the combination of sintilimab + pemetrexed plus platinum is cost-effective as a first-line therapy in Chinese patients with nonsquamous NSCLC who are negative for targetable genetic variations from the perspective of the healthcare system.

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Determining the optimal PD‐1/PD‐L1 inhibitors for the first‐line treatment of non‐small‐cell lung cancer with high‐level PD‐L1 expression in China

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 10 publications

References 36 publications

Economic evaluation of five first-line PD-(L)1 inhibitors for treating non-squamous non-small cell lung cancer in China: A cost-effectiveness analysis based on network meta-analysis

Economic evaluation of five first-line PD-(L)1 inhibitors for treating non-squamous non-small cell lung cancer in China: A cost-effectiveness analysis based on network meta-analysis

Cost-effectiveness analysis of serplulimab combined with chemotherapy in the treatment of extensive-stage small-cell lung cancer from the perspective of the healthcare system in China

Comparing the cost-effectiveness of sintilimab + pemetrexed plus platinum and pemetrexed plus platinum alone as a first-line therapy for Chinese patients with nonsquamous non-small cell lung cancer

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