Chen Feng, Feng Xue, Xiao Lin Lin, Tang Hai Juan, Qin Shu Xia, Peng Jie Ping, Bai Jing
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Department of Health Economics, School of Information and Management, Guangxi Medical University, Nanning, Guangxi, China.
Front Public Health. 2025 May 30;13:1552734. doi: 10.3389/fpubh.2025.1552734. eCollection 2025.
Extensive-stage small-cell lung cancer (ES-SCLC) poses a formidable challenge due to its aggressive nature and poor prognosis. While immune checkpoint inhibitors have shown promise as part of first-line therapy, their cost-effectiveness and survival benefits in the Chinese healthcare system are not well understood. This study evaluates the cost-effectiveness of first-line tislelizumab combined with chemotherapy versus chemotherapy alone for ES-SCLC.
We conducted a cost-effectiveness analysis using a partitioned survival mode (PSM) to compare tislelizumab plus chemotherapy versus chemotherapy alone for the first-line treatment of ES-SCLC. The model integrated survival estimates from the RATIONALE-312 Phase III clinical trial, direct medical costs, and quality-adjusted life year (QALY) sourced from the literature. We calculated 10-year cost per QALY gained from Chinese healthcare system perspective. The analysis of cost-effectiveness was benchmarked against a willingness-to-pay threshold three times of GDP per capita in China. Sensitivity analyses were conducted to evaluate parametric uncertainty and model robustness.
Compared to the chemotherapy alone group, the tislelizumab plus chemotherapy group resulted in an incremental cost-effectiveness ratio (ICER) of US$31,072.79 per quality-adjusted life-year (QALY), which is below the threshold of US$37,765 per QALY. Sensitivity analyses indicated that the utility value of progression-free survival (PFS) is a principal determinant of the ICER, with the ratio fluctuating between $27,246 and $36,417 per QALY, well below the willingness-to-pay threshold. In scenario analyses, tislelizumab plus chemotherapy resulted in an ICER of US$ 38,665.59/QALY with PET-CT imaging (exceeding the $37,765/QALY threshold) but was cost-effective at US$ 30,076.37/QALY when imported topotecan was used as second-line treatment.
Tislelizumab plus chemotherapy demonstrates cost-effectiveness in the first-line treatment of ES-SCLC in China. This study provides preliminary evidence for the economic value of tislelizumab in the treatment of ES-SCLC, supporting its consideration as a first-line therapeutic option.
广泛期小细胞肺癌（ES-SCLC）因其侵袭性和预后不良而构成严峻挑战。虽然免疫检查点抑制剂作为一线治疗的一部分已显示出前景，但其在中国医疗体系中的成本效益和生存获益尚不清楚。本研究评估一线替雷利珠单抗联合化疗与单纯化疗治疗ES-SCLC的成本效益。
我们采用分区生存模型（PSM）进行成本效益分析，以比较替雷利珠单抗联合化疗与单纯化疗用于ES-SCLC的一线治疗。该模型整合了RATIONALE-312 III期临床试验的生存估计、直接医疗成本以及来自文献的质量调整生命年（QALY）。我们从中国医疗体系的角度计算每获得一个QALY的10年成本。成本效益分析以中国人均国内生产总值三倍的支付意愿阈值为基准。进行敏感性分析以评估参数不确定性和模型稳健性。
与单纯化疗组相比，替雷利珠单抗联合化疗组的增量成本效益比（ICER）为每质量调整生命年（QALY）31,072.79美元，低于每QALY 37,765美元的阈值。敏感性分析表明，无进展生存期（PFS）的效用值是ICER的主要决定因素，该比值在每QALY 27,246美元至36,417美元之间波动，远低于支付意愿阈值。在情景分析中，替雷利珠单抗联合化疗采用PET-CT成像时的ICER为38,665.59美元/QALY（超过37,765美元/QALY的阈值），但当进口拓扑替康用作二线治疗时，成本效益为30,076.37美元/QALY。
替雷利珠单抗联合化疗在中国ES-SCLC的一线治疗中显示出成本效益。本研究为替雷利珠单抗治疗ES-SCLC的经济价值提供了初步证据，支持将其作为一线治疗选择加以考虑。
