Abstract
Background
Tislelizumab combined with chemotherapy has shown significant clinical benefits in improving overall survival compared to chemotherapy alone for patients with extensive-stage small-cell lung cancer (ES-SCLC).
Aim
This study aimed to evaluate its cost-effectiveness for both US and Chinese ES-SCLC patient populations.
Method
We conducted an economic evaluation using a Markov state-transition model, reflecting the perspectives of US and Chinese healthcare payers. Baseline patient characteristics and essential clinical data were obtained from the RATIONALE-312 trial. The costs and utilities were derived from open-access databases and published literature. The primary outcomes measured included quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), incremental net health benefit (INHB), and incremental net monetary benefit (INMB). Uncertainties in the model were addressed by probabilistic sensitivity analysis (PSA) and one-way sensitivity analysis (OWSA).
Results
In the base-case analysis, the addition of tislelizumab to chemotherapy provided an incremental gain of 0.27 QALYs at an additional cost of $8,352.18, resulting in an ICER of $31,136.52 per QALY. Although below the willingness-to-pay (WTP) threshold of China of $38,042.49 per QALY, the cost-effectiveness was marginal, with an INHB of 0.05 QALYs and an INMB of $1,852.49. In the US, despite a slightly higher effectiveness gain of 0.29 QALYs, the increased cost of $45,157.35 resulted in an unfavorable ICER of $157,117.67 per QALY, exceeding the US WTP threshold of $150,000.00. PSA showed probabilities of cost-effectiveness of tislelizumab plus chemotherapy at 92.52% in China and 44.07% in the US.
Conclusions
Tislelizumab with chemotherapy may be a cost-effective first-line treatment option for ES-SCLC in China but not the US, highlighting significant geographical disparities in healthcare economics.