Background Toripalimab combined with chemotherapy has demonstrated significant clinical advantages in improving overall survival compared with chemotherapy alone as a first-line treatment for extensive-stage small-cell lung cancer (ES-SCLC). Method An economic evaluation was conducted using a Markov state-transition model to reflect the perspectives of the United States payer and Chinese healthcare systems. Primary outcomes included quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefit (INHB), and incremental net monetary benefit (INMB). Results Base-case analysis indicated that incorporating toripalimab into chemotherapy produced an ICER of 45, 629. 27 per QALY, exceeding China’s willingness-to-pay (WTP) threshold of 38, 042. 49 per QALY. Subgroup analyses revealed ICERs of 22, 345. 99 and 30, 867. 38 per QALY for patients with low intratumor heterogeneity (ITH-L) and A11+/B62- histology, respectively, both below the China WTP threshold. In contrast, in the United States, the additional cost led to unfavorable ICERs of 842, 855. 23, 328, 694. 61, and 520, 412. 03 per QALY for the overall population, the ITH-L subgroup, and the A11+/B62− subgroup, respectively, each exceeding the United States WTP threshold of 150, 000. 00. Conclusion The combination of toripalimab and chemotherapy was not found to be a cost-effective first-line treatment for ES-SCLC in China or the United States, except for patients in China with ITH-L and A11+/B62- histology.
Ouyang et al. (Wed,) studied this question.
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