Abstract
Objective: Camrelizumab is the first domestic PD-1inhibitor approved to be combined with chemotherapy as a first-line therapy for advanced nonsquamous non–small-cell lung cancer (NSCLC) in China. The purpose of this study was to determine whether using camrelizumab in the first-line setting is cost-effective in China when compared with traditional chemotherapy or the imported PD-1inhibitor pembrolizumab. Material and Methods: A Markov model was built to simulate 3-week patient transitions over a 30-year horizon from the perspective of the Chinese healthcare system. Health states included stable disease, first progression, second progression, and death. A direct comparison between first-line camrelizumab in combination with pemetrexed and carboplatin (CPC) and pemetrexed plus carboplatin (PC) was performed by calculating transition probabilities from the CameL trial. An indirect comparison between first-line CPC and pembrolizumab in combination with pemetrexed and platinum (PPP) was performed by calculating transition probabilities using a network meta-analysis. Costs in the Chinese setting were collected from the local public database and literatures. Sensitivity analyses explored the uncertainty around model parameters. Results: In the primary analysis, first-line CPC gained an additional 0.41 quality-adjusted life-years (QALYs) with an incremental cost of $3,486 compared with PC, resulting in an incremental cost-effectiveness ratio (ICER) of $8,378 per QALY gained. In the secondary analysis, first-line PPP yielded an additional 0.10 QALYs at an incremental cost of $6,710, resulting in an ICER of $65,563 per QALY gained. Conclusion: For Chinese patients with advanced nonsquamous NSCLC without targetable genetic aberrations, our primary analysis results supported first-line CPC as a cost-effective treatment compared with traditional PC chemotherapy. The findings of our secondary analysis suggested that first-line PPP would not be a cost-effective option compared with first-line CPC. This analysis provided strong evidence for promoting the widespread use of first-line CPC in China and, to some extent, stimulated the enthusiasm for the development of domestic cancer drugs.
Highlights
In China, first-line platinum-doublet chemotherapy remained the category one recommendation for advanced nonsquamous non–small-cell lung cancer (NSCLC) without targetable genetic aberrations (Zhou et al, 2021a), immunotherapy with remarkable efficacy has been approved by the Chinese National Medical Products Administration (NMPA) in recent years (Gandhi et al, 2018; Wu et al, 2021)
We considered the costs of first-line and subsequent treatment, treating adverse events (AEs), and general treatment associated with disease management including routine follow-up, best support care (BSC), and end-of-life care
First-line combination with pemetrexed and carboplatin (CPC) prolonged survival by 0.41 quality-adjusted life-years (QALYs) (1.57 vs. 1.16 QALYs), which was approximately equivalent to 5 months of perfect health, while increasing health care costs by $3,486 ($11,519 vs. $8,082) compared to the first-line plus carboplatin (PC)
Summary
In China, first-line platinum-doublet chemotherapy remained the category one recommendation for advanced nonsquamous non–small-cell lung cancer (NSCLC) without targetable genetic aberrations (Zhou et al, 2021a), immunotherapy with remarkable efficacy has been approved by the Chinese National Medical Products Administration (NMPA) in recent years (Gandhi et al, 2018; Wu et al, 2021). The approval of camrelizumab in combination with pemetrexed and carboplatin (CPC) was in response to the result of a phase three clinical trial (CameL) to evaluate its efficacy against nonsquamous NSCLC without targetable genetic aberrations in China (Zhou et al, 2021b). This trial demonstrated that compared with pemetrexed plus carboplatin (PC), first-line CPC significantly prolonged the progression-free survival (PFS) by a median of 3 months (median, 11.3 vs 8.3 months).
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