# Comparative cost-effectiveness of sintilimab, toripalimab, and camrelizumab in first-line therapy for advanced non-squamous non-small cell lung cancer

## TL;DR

This study compares the cost-effectiveness of three PD-1 inhibitors for treating advanced non-squamous lung cancer in China, finding camrelizumab to be the most cost-effective option.

## Contribution

The study provides the first comparative cost-effectiveness analysis of sintilimab, toripalimab, and camrelizumab in China's medical insurance system.

## Key findings

- Sintilimab had the lowest cost but fewer quality-adjusted life-years (QALYs) compared to camrelizumab.
- Camrelizumab showed the highest QALYs with an incremental cost-effectiveness ratio below the willingness-to-pay threshold.
- Toripalimab was strictly dominated due to higher costs without additional benefits.

## Abstract

Several PD-1 inhibitors used in first-line treatment of advanced non-squamous non–small cell lung cancer in China, including sintilimab, toripalimab and camrelizumab, have demonstrated significant survival benefits in phase III trials. However, their comparative cost-effectiveness within the Chinese national medical insurance system remains unclear.

A Markov model with progression-free, progressive disease and death states was developed from the Chinese national medical insurance system payer perspective. Clinical efficacy inputs were obtained from three China-based phase III randomized trials. Individual patient data were reconstructed from published Kaplan–Meier curves using the Guyot method, and parametric survival models were fitted for extrapolation. Costs included drug acquisition, administration, adverse event management and post-progression therapy. Outcomes were total costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). One-way and probabilistic sensitivity analyses were conducted.

Sintilimab incurred the lowest cost (230,813 CNY) and generated 1.1 QALYs. Toripalimab yielded the same QALYs at a higher cost and was strictly dominated. Camrelizumab produced the highest QALYs (1.2) at a total cost of 253,056 CNY. Compared with sintilimab, camrelizumab had an ICER of 164,983 CNY/QALY, below the willingness-to-pay threshold of 287,247 CNY/QALY. Sensitivity analyses confirmed the robustness of these findings.

Among the three domestic PD-1 inhibitors evaluated, camrelizumab is the most cost-effective first-line treatment option for advanced non-squamous NSCLC in China.