Abstract
Objective: The CAMEL clinical trial (412 patients were randomly assigned to either camrelizumab plus chemotherapy (n = 205) or chemotherapy alone (n = 207)) demonstrated that camrelizumab plus chemotherapy (CC) improved the overall survival time (OS) and progression-free survival time (PFS) of patients with metastatic nonsquamous non-small cell lung cancer (non-sq NSCLC) without epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) mutations (EGFRm and ALKm) vs. chemotherapy (C) alone. Our objective was to conduct a cost-effectiveness analysis of CC vs. C from a perspective of health - care system in China with a lifetime horizon to identify whether it will be cost-effective. Materials and Methods: A partitioned survival model (PSM) was applied for patients with IIIB–IV non-sq NSCLC without EGFRm and ALKm. Transition parameters and proportions of three health states were derived from the CAMEL trial. The model was designed using a lifetime horizon, a 21-day cycle, and a 5% discount rate of costs and outcomes. It was deemed cost-effective in China if the incremental cost-effectiveness ratio (ICER) value is less than $32,457 per quality adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses were performed to verify the influence of parameter uncertainty on the results. Results: In the base-case analysis, we found that the ICER of CC compared with C is $-7,382.72/QALY which meant that CC had lower costs and better outcomes. The results of the sensitivity analyses demonstrated that the result was robust for the ICERs never transcending the willingness-to-pay (WTP) threshold. Conclusion: Camrelizumab plus chemotherapy is an obviously cost-effective therapeutic regime for patients of IIIB–IV non-sq NSCLC without EGFRm and ALKm in China at a $32,457 WTP threshold.
Highlights
Lung carcinoma is the most common malignancy all over the world
Under the circumstance of the decreased price of camrelizumab from $3060.3 to $452.6, our results showed that CC strategy produced an extra 0.39 QALYs while saving $2,898.85, which resulted in an ICER of $-7,382.72/QALY
These findings suggested that the CC strategy was absolutely cost-effective in China, which was also proved by the CEACs (Figure 8)
Summary
Lung carcinoma is the most common malignancy all over the world. It is the most frequent cause of cancer-related death in human beings, which is estimated to be accountable for nearly 1/5 deaths for cancer (Fitzmaurice et al, 2018). A meta-analysis (Ferrara et al, 2020) shows that single-agent ICI in patients with NSCLC and PD-L1 ≥50% probably lead to a higher OS rate (hazard ratio (HR) 0.68, 95% confidence interval (CI) [0.60–0.76]) and may improve PFS (HR 0.68, 95% CI [0.52–0.88]) and overall response rate (ORR) (risk ratio (RR) 1.40, 95% CI [1.12–1.75]) when compared to platinum-based chemotherapy and may lead to a lower rate of adverse events (AEs) (RR 0.41, 95% CI [0.33–0.50]) and higher health-related quality of life (HRQoL) (RR 1.51, 95% CI [1.08–2.10]). In June 2020, the combination regimen of camrelizumab + standard chemotherapy (platinum and pemetrexed), as the first-line therapy for patients with metastatic non-sq NSCLC without EGFRm or ALKm, was approved by the National Medical Products Administration (NMPA) in China and was included in the Guidelines of Chinese Society of Clinical Oncology (CSCO) (Non-Small Cell Lung Cancer) (CSoCOC, 2020). The therapeutic regime mentioned above has been included in 2020 national medical insurance catalogue with more than 85% reduction in the price of camrelizumab
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