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Cost-Effectiveness Analysis of Sintilimab Plus Chemotherapy in Advanced Non-Squamous Non-Small Cell Lung Cancer: A Societal Perspective

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Abstract

Introduction

The updated ORIENT-11 study demonstrated that sintilimab, when combined with chemotherapy, had promising survival advantage compared to standard chemotherapy alone in the first-line treatment for previously untreated, locally advanced or metastatic non-squamous non-small cell lung cancer (nsNSCLC). This study aims to evaluate the cost-effectiveness of sintilimab plus chemotherapy for advanced nsNSCLC from a Chinese societal perspective.

Methods

A partitioned survival model with a embedded decision tree was developed to assess the economic value of sintilimab plus chemotherapy over a lifetime horizon. Clinical data was captured from the updated ORIENT-11 study, while costs, health productivity losses, and utility values were collected from a nationwide cross-sectional survey in tertiary hospitals across multiple provinces in China. The primary outcomes were measured using the metrics of quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICER). Costs and health outcomes were discounted at an annual rate of 5% per annum. Sensitivity analyses, including one-way and probabilistic sensitivity analyses, subgroup analyses, and scenario analyses, were performed.

Results

Compared to standard chemotherapy, treatment with sintilimab plus chemotherapy incurred a mean total cost of $23,979 and gained 0.98 QALYs over the lifetime horizon, resulting in an ICER of $24,568 per QALY gained. The use of sintilimab accumulated direct non-medical costs of $9262 and indirect costs of $6780 over 16 years. Probabilistic sensitivity analyses showed an 84.2% probability of sintilimab plus chemotherapy being cost-effective at a threshold of three times China’s per capita gross domestic product in 2022 ($38,201). The model was most sensitive to the discount rate of QALYs and costs, as well as the costs of pemetrexed, sintilimab, and subsequent therapy in progressive disease state. Subgroup analyses indicated favorable incremental net monetary benefits in all subgroups.

Conclusion

Sintilimab plus chemotherapy is a cost-effective first-line treatment therapy for advanced nsNSCLC in China when compared to standard chemotherapy. These findings, along with the improved progression-free survival and overall survival (OS) observed in ORIENT-11, support the use of this regimen in eligible candidates for advanced nsNSCLC.

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Data Availability

All data generated or analyzed during this study are included in this published article/as supplementary information files.

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Funding

This study and its publication were supported by the Excellent Youth Project of the three-year action plan to strengthen the public health system in Shanghai (GWVI-11.2-YQ57). No funding or sponsorship was received for the publication of this article.

Author information

Authors and Affiliations

  1. School of Public Health, Fudan University, Shanghai, People’s Republic of China

    Fuming Li, Yingyao Chen, Dunming Xiao & Yi Yang

  2. National Health Commission Key Laboratory of Health Technology Assessment (Fudan University), Shanghai, People’s Republic of China

    Fuming Li, Yingyao Chen, Dunming Xiao & Yi Yang

  3. Macquarie University Centre for the Health Economy, Macquarie Business School and Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia

    Shan Jiang

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  1. Fuming Li
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Contributions

Fuming Li: Study concepts and design, formal analysis, methodology, visualization, drafting the manuscript. Yingyao Chen: Study concepts and design, data curation, resources, supervision, manuscript review and editing. Dunming Xiao: Formal analysis, methodology, and software. Shan Jiang: Methodology, supervision, manuscript review and editing. Yi Yang: Study concepts and design, data curation, formal analysis, resources, supervision, manuscript review and editing.

Corresponding author

Correspondence to Yi Yang.

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Conflict of Interest

Fuming Li, Yingyao Chen, Dunming Xiao, and Yi Yang declare that they have no relevant financial or non-financial interests to disclose. Shan Jiang is an Editorial Board member of Advances in Therapy. Shan Jiang was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions.

Ethical Approval

This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

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Li, F., Chen, Y., Xiao, D. et al. Cost-Effectiveness Analysis of Sintilimab Plus Chemotherapy in Advanced Non-Squamous Non-Small Cell Lung Cancer: A Societal Perspective. Adv Ther 41, 1436–1449 (2024). https://doi.org/10.1007/s12325-024-02808-x

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