Cost-effectiveness of perioperative toripalimab plus chemotherapy for stage III resectable non-small cell lung cancer in China

For resectable stage III non-small cell lung cancer (NSCLC), postoperative recurrence remains common. Neotorch showed that perioperative toripalimab plus chemotherapy improved event-free survival (EFS) and major pathological response (MPR), but its cost-effectiveness in China remains uncertain. A five-state Markov model compared perioperative toripalimab plus chemotherapy (the “3+1+13 ” regimen) with placebo plus chemotherapy over 30 years from the Chinese healthcare system perspective. Clinical inputs were obtained from Neotorch and published literature. Outcomes included costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs), evaluated against willingness-to-pay thresholds of $38,223/QALY and $12,741/QALY. One-way and probabilistic sensitivity analyses, scenario analyses, and exploratory matched pathological-response subgroup analyses were conducted. Toripalimab plus chemotherapy increased costs by $5,395 and QALYs by 1.50, yielding an ICER of $3,598.32/QALY. All ICERs in the one-way and scenario analyses remained below $12,741/QALY. Under the specified parameter distributions, the probability of cost-effectiveness was > 99% at both thresholds in 10,000 probabilistic iterations. Exploratory matched subgroup ICERs were $2,658.55/QALY for MPR and $5,175.33/QALY for non-MPR. From the Chinese healthcare system perspective, perioperative toripalimab plus chemotherapy was estimated to be cost-effective for resectable stage III NSCLC. The “3+1+13” regimen showed a favorable cost-effectiveness profile under the modeled assumptions.