Abstract
Background: As the first domestic PD-1 antibody approved for lung cancer in China, camrelizumab has exhibited proven effectiveness for non-small-cell lung cancer (NSCLC) patients. However, the cost-effectiveness of this new regimen remains to be investigated.Objective: To evaluate the cost-effectiveness of camrelizumab combination therapy vs. chemotherapy for previously untreated patients with advanced, non-squamous NSCLC without Alk or Egfr genomic aberrations from the perspective of China's healthcare system.Methods: Based on the CameL trial, the study developed a three-health state Markov model to evaluate the cost-effectiveness of adding camrelizumab to chemotherapy compared to chemotherapy alone in NSCLC patients. The analysis models were conducted for patients unselected by PD-L1 tumor expression (the base case) and the patient subgroup with PD-L1-expressing tumors (≥1%). Primary model outcomes included the costs in US dollars and health outcomes in quality-adjusted life-years (QALYs) as well as the incremental cost-effectiveness ratio (ICER) under a willingness-to-pay threshold of $31,500 per QALY. Additionally, a scenario analysis that adjusted within-trial crossover was employed to evaluate camrelizumab combination therapy compared to chemotherapy without subsequent use of PD1/PD-L1 antibodies.Results: Camrelizumab combination therapy was more costly and provided additional 0.11 QALYs over chemotherapy in the base case analysis (0.86 vs. 0.75 QALYs), 0.12 QALYs over chemotherapy in the subgroup analysis (0.99 vs. 0.88 QALYs), and 0.34 QALYs over chemotherapy in the scenario analysis (0.86 vs. 0.52 QALYs). Correspondingly, the ICER was $63,080 per QALY, $46,311 per QALY, and $30,591 per QALY, in the base case, the subgroup, and the scenario analysis, respectively. One-way sensitivity analyses revealed that ICERs of the base case and the subgroup analysis were most sensitive to the cost of camrelizumab, the cost of pemetrexed. Besides, the base case and subgroup analysis were more sensitive to the risk of neutrophil count decreased in the camrelizumab and the utility of stable disease, respectively.Conclusion: Although camrelizumab combination therapy is not cost-effective as first-line therapy for NSCLC patients in China in the base case, adjusting within-trial crossover would move the treatment regimen toward cost-effectiveness in the scenario analysis.
Highlights
Non-small-cell lung cancer (NSCLC) is the most common subtype of lung cancer, accounting for ∼85% of lung cancer diagnoses and the leading cause of cancer-related mortality in China [1, 2]
In the base case analysis, pemetrexed-platinum chemotherapy treatment was associated with a mean cost of $12,983 and a mean quality-adjusted survival of 0.75 qualityadjusted life-years (QALYs) in patients unselected by programmed cell death ligand 1 (PD-L1) tumor expression
Adding camrelizumab to pemetrexed-platinum chemotherapy resulted in a mean cost of $19,921 and a mean quality-adjusted survival of 0.86 QALY, yielding an estimated incremental costeffectiveness ratio (ICER) of $63,080 per QALY (Table 2)
Summary
Non-small-cell lung cancer (NSCLC) is the most common subtype of lung cancer, accounting for ∼85% of lung cancer diagnoses and the leading cause of cancer-related mortality in China [1, 2]. The CameL trial (ClinicalTrials.gov identifier NCT03134872), a multicentre randomized phase 3 trial, evaluated the combination of camrelizumab and pemetrexedplatinum chemotherapy (camrelizumab combination therapy) for previously untreated patients with advanced, non-squamous NSCLC without Alk or Egfr genomic aberrations. In this trial, camrelizumab significantly prolonged median progression-free survival (PFS) by 3 months [11.3 vs 8.3 months, hazard ratio (HR), 0.60; 95% confidence interval (CI), 0.45–0.79] and the median overall survival (OS) by 7.4 months (27.9 vs 20.5 months, HR, 0.73, IC, 0.55–0.96) for patients receiving camrelizumab in comparison to placebo [7, 8]. The cost-effectiveness of this new regimen remains to be investigated
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