Lang Wenwang, Wang Jiangbo, Zhao Haiqing, He Yulong, Jiang Qinling, Ai Qi, Ouyang Ming
Department of Pharmacy, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, 541002, China.
Department of Oncology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, Guilin, China.
Clin Transl Oncol. 2025 Aug 21. doi: 10.1007/s12094-025-04035-4.
Socazolimab, in combination with chemotherapy, has been shown to prolong progression-free survival (PFS) and overall survival (OS) compared with chemotherapy alone in patients with extensive-stage small cell lung cancer (ES-SCLC). This study is the first to evaluate its cost-effectiveness from the perspectives of both the U.S. payer and Chinese healthcare systems.
A Markov state-transition model was employed to conduct an economic evaluation, incorporating clinical and economic parameters from both the U.S. and China. Baseline patient characteristics and key clinical inputs were sourced from a randomized phase 3 trial, whereas cost and utility values were derived from open-access databases and published literature. The primary outcomes assessed included quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefit (INHB), and incremental net monetary benefit (INMB). Model uncertainty was addressed through probabilistic sensitivity, one-way sensitivity, and scenario analyses.
In the base-case scenario, the addition of socazolimab to chemotherapy resulted in a marginal QALY gain of 0.09, at an incremental cost of $14,504.53, leading to an ICER of $152,228.60 per QALY. This ICER was below China's willingness-to-pay (WTP) threshold of $40,354.27 per QALY, making it not cost-effective, with an INHB of -0.26 QALYs and an INMB of -$10,523.93. In the U.S., while the incremental QALY gain remained at 0.10, the additional cost increased to $85,599.55, yielding an ICER of $878,912.80 per QALY, far exceeding that of the U.S. WTP threshold of $150,000.00, confirming its lack of cost-effectiveness.
The combination of socazolimab with chemotherapy is not a cost-effective first-line treatment option for ES-SCLC in either China or the United States, highlighting the need for price adjustments and alternative treatment strategies to improve economic viability.
与单纯化疗相比，索卡唑单抗联合化疗已被证明可延长广泛期小细胞肺癌（ES-SCLC）患者的无进展生存期（PFS）和总生存期（OS）。本研究首次从美国医保支付方和中国医疗体系的角度评估其成本效益。
采用马尔可夫状态转移模型进行经济评估，纳入来自美国和中国的临床及经济参数。基线患者特征和关键临床数据来源于一项随机3期试验，而成本和效用值则来自开放获取数据库及已发表文献。评估的主要结果包括质量调整生命年（QALY）、增量成本效益比（ICER）、增量净健康效益（INHB）和增量净货币效益（INMB）。通过概率敏感性分析、单因素敏感性分析和情景分析来处理模型的不确定性。
在基础情景下，索卡唑单抗联合化疗使QALY略有增加0.09，增量成本为14,504.53美元，导致ICER为每QALY 152,228.60美元。该ICER低于中国每QALY 40,354.27美元的支付意愿（WTP）阈值，因此不具有成本效益，INHB为 -0.26 QALY，INMB为 -10,523.93美元。在美国，虽然增量QALY增加仍为0.10，但额外成本增至85,599.55美元，ICER为每QALY 878,912.80美元，远远超过美国150,000.美元的WTP阈值，证实其缺乏成本效益。
在中国和美国，索卡唑单抗联合化疗都不是ES-SCLC具有成本效益的一线治疗选择，这凸显了调整价格和采用替代治疗策略以提高经济可行性的必要性。
