Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
Front Public Health. 2023 Feb 27;11:1054405. doi: 10.3389/fpubh.2023.1054405. eCollection 2023.
Sugemalimab is a newly developed inhibitor of programmed death ligand 1 (PD-L1). As a first-line treatment for metastatic non-small-cell lung cancer (NSCLC), sugemalimab plus chemotherapy (Sugema-Chemo) has been proven effective. Still, its cost-effectiveness has not yet been determined. The objective of this study was to assess the cost-effectiveness of Sugema-Chemo from a health care perspective in China.
A partitioned survival model was used. According to the GEMSTONE-302 trial, the clinical characteristics and outcomes of the patients were obtained. The outcomes were costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefits (INHB) and incremental net monetary benefits (INMB). The robustness of the model was further evaluated, as well as subgroup analyses. When the ICER was lower than the willingness to pay (WTP) threshold ($38,017/QALY or $86,376/QALY, defined as three times the per capita gross domestic product value of the general region and Beijing), the cost-effectiveness of Sugema-Chemo was assumed for general regions or Beijing.
Compared with chemotherapy alone, Sugema-Chemo resulted in an incremental gain of 0.82 QALYs, an incremental gain of 1.26 life-years, as well as an average increase cost of $72,472. The ICER was $88,744/QALY. Model outcomes were susceptible to average body weight and cost of sugemalimab. Sugema-Chemo was cost-effective at a WTP threshold of 86,376/QALY if the average body weight was <62.44 kg or if the price of sugemalimab was <$2.996/mg. As well, Sugema-Chemo was also cost-effective when the cost of sugemalimab was <$1.839/mg for a WTP threshold of $38,017/QALY. Sugema-Chemo had a probability of > 50% being considered cost-effective in most subgroups at the $86,376/QALY threshold. However, Sugema-Chemo did not achieve cost-effectiveness (0%) in any of the subgroups when WTP was set at $38,017/QALY.
Sugema-Chemo might not be cost-effective in patients with metastatic NSCLC in China. In deciding between Sugema-Chemo and chemotherapy alone, it is essential to consider both the body weight of patients and the price of sugemalimab. A price reduction of sugemalimab under the National Healthcare Security Administration may be an effective measure to improve the cost-effectiveness of the drug.
舒格利单抗是一种新开发的程序性死亡配体 1（PD-L1）抑制剂。作为转移性非小细胞肺癌（NSCLC）的一线治疗药物，舒格利单抗联合化疗（Sugema-Chemo）已被证明有效。然而，其成本效益尚未确定。本研究旨在从中国卫生保健的角度评估 Sugema-Chemo 的成本效益。
采用分割生存模型。根据 GEMSTONE-302 试验，获得患者的临床特征和结局。结果为成本、质量调整生命年（QALYs）、增量成本效果比（ICER）、增量净健康收益（INHB）和增量净货币收益（INMB）。进一步评估了模型的稳健性，并进行了亚组分析。当 ICER 低于意愿支付（WTP）阈值（$38,017/QALY 或$86,376/QALY，定义为一般地区和北京人均国内生产总值的三倍）时，假设 Sugema-Chemo 在一般地区或北京具有成本效益。
与单独化疗相比，Sugema-Chemo 可使 QALYs 增加 0.82 个，使寿命增加 1.26 年，平均增加成本$72,472。ICER 为$88,744/QALY。模型结果易受平均体重和舒格利单抗成本的影响。如果平均体重<62.44kg 或舒格利单抗的价格<$2.996/mg，Sugema-Chemo 在 WTP 阈值为$86,376/QALY 时具有成本效益。当舒格利单抗的价格<$1.839/mg 时，Sugema-Chemo 在 WTP 阈值为$38,017/QALY 时也具有成本效益。在$86,376/QALY 的阈值下，Sugema-Chemo 在大多数亚组中具有超过 50%的可能性被认为是具有成本效益的。然而，当 WTP 设定为$38,017/QALY 时，Sugema-Chemo 在任何亚组中均不具有成本效益（0%）。
在中国，转移性非小细胞肺癌患者使用 Sugema-Chemo 可能没有成本效益。在选择 Sugema-Chemo 与单独化疗时，必须考虑患者的体重和舒格利单抗的价格。国家医疗保障局降低舒格利单抗的价格可能是提高该药物成本效益的有效措施。
