Yang Jing, Chen Fang, Li Junlin, Zhou Yujie, Wang Hao, Long Yunchun
Department of Pharmacy, Chengdu Second People's Hospital, Chengdu, Sichuan, China.
Department of Pharmacy, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China.
Front Immunol. 2025 May 16;16:1556100. doi: 10.3389/fimmu.2025.1556100. eCollection 2025.
Toripalimab combined with chemotherapy is a clinically valuable and important regimen in the treatment of extensive-stage small-cell lung cancer (ES-SCLC). However, there are no studies on the cost-effectiveness of this regimen, so this study was designed to evaluate the cost-effectiveness of Toripalimab regimen for the treatment of ES-SCLC from the perspectives of the Chinese health system and the U.S. health system, respectively.
A partitioned survival model was developed to simulate the clinical progression and cost consumption of ES-SCLC using the results of the EXTENTORCH study as a source of survival data and incorporating direct medical costs. Model output metrics included incremental cost-effectiveness ratio (ICER), quality-adjusted life-years (QALYs), incremental QALYs, total costs, and incremental costs. The cost-effectiveness of the Toripalimab scheme was judged by comparing the ICER with the willingness to pay (WTP). The robustness of the model was verified by sensitivity analysis and scenario analysis.
The results of the basic analysis showed that from the perspective of the Chinese health system, the Toripalimab group gained 0.18 QALYs more at a cost of $5,204, with an ICER of $29,139/QALY (<WTP). From the standpoint of the U.S. health system, the Toripalimab group spent $156,923 more and also gained 0.17 QALYs more, but the ICER ($915,965/QALY) was much higher than the WTP. Sensitivity and scenario analyses showed the model to be generally stable.
Compared with chemotherapy, the Toripalimab regimen for the treatment of ES-SCLC is cost-effective from the perspective of the Chinese health system, but not from the perspective of the US health system.
托瑞帕利单抗联合化疗是广泛期小细胞肺癌（ES-SCLC）治疗中具有临床价值且重要的方案。然而，尚无关于该方案成本效益的研究，因此本研究旨在分别从中国卫生系统和美国卫生系统的角度评估托瑞帕利单抗方案治疗ES-SCLC的成本效益。
建立一个分区生存模型，以EXTENTORCH研究结果作为生存数据来源并纳入直接医疗成本，模拟ES-SCLC的临床进展和成本消耗。模型输出指标包括增量成本效益比（ICER）、质量调整生命年（QALY）、增量QALY、总成本和增量成本。通过比较ICER与支付意愿（WTP）来判断托瑞帕利单抗方案的成本效益。通过敏感性分析和情景分析验证模型的稳健性。
基本分析结果显示，从中国卫生系统角度来看，托瑞帕利单抗组多获得0.18个QALY，成本为5204美元，ICER为29139美元/QALY（<WTP）。从美国卫生系统角度来看，托瑞帕利单抗组多花费156923美元，也多获得0.17个QALY，但ICER（915965美元/QALY）远高于WTP。敏感性和情景分析表明模型总体稳定。
与化疗相比，从中国卫生系统角度来看，托瑞帕利单抗方案治疗ES-SCLC具有成本效益，但从美国卫生系统角度来看则不然。
