Cost-effectiveness analysis of tislelizumab plus chemotherapy versus placebo plus chemotherapy as first-line treatment for extensive-stage small cell lung cancer in China

TL;DR

This study shows that adding tislelizumab to chemotherapy for a type of lung cancer may be cost-effective in China based on survival benefits and economic models.

Contribution

The study evaluates the cost-effectiveness of tislelizumab plus chemotherapy for ES-SCLC in China using two models and sensitivity analyses.

Findings

The ICERs for tislelizumab were CNY 216,041.10/QALY and CNY 206,915.66/QALY using two models.

Tislelizumab had a high probability of being cost-effective at China's WTP threshold.

Key factors influencing cost-effectiveness were progression-free survival utility and etoposide cost.

Abstract

The RATIONALE-312 trial demonstrated that the combination of tislelizumab with chemotherapy significantly improved the survival benefits for patients with extensive-stage small cell lung cancer (ES-SCLC). In this study, we used two models to evaluate the cost-effectiveness of tislelizumab in combination with chemotherapy as a first-line treatment for ES-SCLC patients from the perspective of China’s healthcare system.

Based on the RATIONALE-312 trial data, a Markov model and a partitioned survival (PS) model were developed to assess the cost-effectiveness of tislelizumab in combination with chemotherapy as first-line treatment for ES-SCLC. The models set a 3-week cycle length and 10-year time horizon. Cost and utility values were obtained from the drug data service platform and published studies. Primary outcomes measured in the models included total costs, life-years (LYs), quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). Furthermore, one-way and probabilistic sensitivity analyses (PSA) were conducted to verify robustness of the models.

In the base-case analysis, the ICERs based on the Markov model and the PS models of tislelizumab group were CNY 216,041.10/QALY and CNY 206,915.66/QALY, respectively, compared with placebo group. One-way sensitivity analysis showed that the most influential parameters on the ICER were the utility of progression-free survival, and the cost of etoposide. The PSA indicated that at the current willingness-to-pay (WTP) threshold of CNY 268,074 per QALY, the probability of tislelizumab being cost-effective in two models was 93.60 and 86.70%, respectively.

At the current WTP threshold in China, the combination of tislelizumab and chemotherapy may be cost-effective as a first-line treatment for patients with ES-SCLC.

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