In a pivotal study comparing the cost-effectiveness of camrelizumab plus paclitaxel and carboplatin (CTC) versus sintilimab plus gemcitabine and cisplatin or carboplatin (SGP) for the first-line treatment of locally advanced or metastatic squamous non-small cell lung cancer (sqNSCLC), researchers set out to determine which therapy offers better economic and clinical outcomes. Both treatments have been approved by China’s National Medical Products Administration (NMPA), but direct comparisons have been scarce.
Methodology and Analysis
Researchers employed a network meta-analysis using three clinical trials—CameL-Sq, ORIENT-12, and C-TONG1002—to assess the clinical benefits of CTC and SGP. To further evaluate life expectancy associated with the treatments, a Weibull approximation was used. Then, a partitioned survival model (PSM) was created to simulate patient outcomes over time. One-way sensitivity analysis and probabilistic sensitivity analysis were conducted, ensuring the robustness of the model parameters and assumptions.
Results and Findings
The study revealed that the CTC treatment resulted in 0.68 quality-adjusted life years (QALYs) at a cost of $14,764, while the SGP treatment provided 0.54 QALYs at $14,584. Despite the CTC arm incurring an additional cost of $179 compared to the SGP arm, it gained 0.14 more QALYs, leading to an incremental cost-effectiveness ratio (ICER) of $1,269 per QALY. Given that the ICER is significantly lower than the GDP per capita of China ($12,734 in 2022), CTC was deemed cost-effective.
Market access plays a crucial role in these findings. With cost-effectiveness being a significant determinant for payer decisions, the study positions CTC as a favorable option for inclusion in healthcare plans, potentially influencing market access dynamics in China.
Concrete Inferences
Key Insights
- CTC provides a higher QALY gain despite a slightly increased cost, making it a cost-effective option.
- The ICER of CTC is well below the one-fold GDP per capita in China, supporting its economic viability.
- Probabilistic sensitivity analysis shows CTC has a higher probability of being cost-effective within willingness-to-pay thresholds.
The conclusion drawn from the study highlights camrelizumab plus chemotherapy as a cost-effective first-line treatment for locally advanced or metastatic sqNSCLC in China, offering better health outcomes at a reasonable incremental cost compared to sintilimab plus chemotherapy.
Original Article:
Front Pharmacol. 2024 Jul 12;15:1356725. doi: 10.3389/fphar.2024.1356725. eCollection 2024.
ABSTRACT
OBJECTIVE: Both camrelizumab plus paclitaxel and carboplatin (CTC) and sintilimab plus gemcitabine and cisplatin or carboplatin (SGP) have been approved by the National Medical Products Administration of China (NMPA) for the first-line treatment of local advanced or metastatic sqNSCLC. However, the comparison of the two treatments as first-line treatments in efficacy or pharmacoeconomics has barely been studied. To deeply understand the costs and outcomes of the two treatments, this work directly compared the cost-effectiveness for the first-line treatment of local advanced or metastatic squamous NSCLC in the Chinese mainland.
METHODS: A network meta-analysis was first performed based on the three clinical trials, namely, CameL-Sq, ORIENT-12, and C-TONG1002, to compare the clinical benefits of the two treatments. The Weibull approximation was applied to further calculate the life expectancy of the two treatments. The partitioned survival model (PSM) was next established, and one-way sensitivity analysis and probabilistic sensitivity analysis were also performed to evaluate the stability of the underlying parameter values and assumptions within the model.
RESULTS: CTC treatment gained 0.68 QALYs and cost $14,764. SGP treatment gained 0.54 QALYs and cost $14,584. The CTC arm gained 0.14 additional QALYs and cost $179 more than the SGP arm, and the ICERs was $1,269/QALY, which was lower than one-fold GDP per capita in the Chinese mainland ($12,734 GDP per capita in 2022). In probabilistic sensitivity analysis, when the WTP ranged from $12,734-38,202 (1-3 folds, 2022 GDP per capita in China), the CTC group had higher probabilities than the SGP group for being cost effective, which ranged from 85.65% to 88.38%.
CONCLUSION: From the perspective of the payers, camrelizumab plus chemotherapy was cost-effective compared with sintilimab plus chemotherapy for the first-line treatment of local advanced or metastatic squamous NSCLC in the Chinese mainland.
PMID:39070786 | PMC:PMC11272525 | DOI:10.3389/fphar.2024.1356725

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