A network meta-analysis of second-line immune checkpoint inhibitors and docetaxel for advanced non-small cell lung cancer: An economic evaluation from China

Background Although previous studies have compared the economic benefits of single immune checkpoint inhibitors (ICIs) and docetaxel, few studies have conducted detailed comparisons of different ICIs within China's medical system. This study wanted to see which of the four ICIs-nivolumab, pembrolizumab, tislelizumab and atezolizumab-was more cost-effective than docetaxel when used as second-line treatment for advanced non-small cell lung cancer (NSCLC) in China. Methods A network meta-analysis was performed based on seven randomized controlled trials to determine hazard ratios for progression-free survival (PFS) and overall survival (OS). The economic assessment built a three-state partitioned survival model, which was done using Excel 2021 to simulate the patient's situation over a period of 10 years, with a cycle every 3 weeks.This analysis is done from the perspective of China's medical insurance payers, including direct medical expenses, using a willingness-to-pay (WTP) threshold of $41,859 per QALY, which is equivalent to three times the per capita GDP of China in 2025. In order to ensure that the model results are reliable, they also performed deterministic sensitivity analysis and probability sensitivity analysis to see if the results were stable. Results Among the four ICIs evaluated, tislelizumab achieved the highest QALYs (1.160) at a cost of $21,403.22, yielding the lowest incremental cost-effectiveness ratio (ICER) of $13,718.12/QALY compared to docetaxel. Nivolumab followed with an ICER of $160,444.64/QALY, Pembrolizumab, and atezolizumab demonstrated ICER of $344,114.24/QALY, and $231,458.82/QALY, respectively. One-way sensitivity analysis identified drug cost as the most influential parameter on the ICER. Probabilistic sensitivity analysis (PSA) confirmed that tislelizumab had a 100% probability of being cost effective at the base WTP threshold. Conclusion From the perspective of China's medical system, tislelizumab is the most cost-effective second-line treatment for advanced non-small cell lung cancer based on current willingness to pay benchmarks.