Non-small cell lung cancer (NSCLC) is the most prevalent malignant tumor in China. This study aimed to compare the cost effectiveness of combined nivolumab and ipilimumab with chemotherapy as a first-line treatment for advanced NSCLC. The findings will contribute to the economic evidence for making clinical and health policy decisions.

Taking a healthcare system perspective, this study used a partitioned survival analysis model to simulate the disease trajectory of advanced NSCLC during first-line treatment over a model cycle of three weeks. The simulation extended over a span of 12 years. A five percent discount was incorporated for both costs and health outcomes. Published clinical efficacy and cost data were extracted from the CheckMate 9LA study (NCT03215706) and drug pricing information was gathered from the YaoZhi website. Utility values were derived from 13 tertiary hospitals in five provinces of China. Base case and sensitivity analyses were also conducted.

The combination of nivolumab and ipilimumab resulted in a lifetime cost of CNY850,068 (USD119,127) and 1.796 quality-adjusted life-years (QALYs), whereas chemotherapy incurred a lifetime cost of CNY276,313 (USD38,722) and a gain of 1.206 QALYs. The incremental cost-effectiveness ratio (ICER) for combination therapy was CNY971,955 (USD136,208) per QALY gained, which was more than three times the average gross domestic product per capita in China (CNY85,698 [USD12,010] in 2022) and indicated that the therapy was not cost effective. Probabilistic sensitivity analysis indicated that the likelihood of nivolumab plus ipilimumab being cost effective, compared with chemotherapy, was 0.02.

Nivolumab plus ipilimumab demonstrated enhanced health outcomes for patients with advanced NSCLC, compared with standard chemotherapy, but the ICER exceeded the acceptable threshold, suggesting that the treatment is not cost effective.

IDegLira is a fixed-ratio combination (FRC) comprising insulin degludec and the glucagon-like peptide-1 receptor agonist (GLP-1RA) liraglutide, used for treating uncontrolled type 2 diabetes mellitus (T2DM) patients. We aimed to compare the long-term clinical and cost outcomes between IDegLira and basal-bolus insulin therapy by analyzing data from the Chinese healthcare system.

The IQVIA Core Diabetes Model was employed to compare the two treatments. Cohort characteristics were derived from DUAL II China in patients with uncontrolled T2DM on basal insulin. Efficacy data were sourced from a published indirect comparative analysis. Utilities, medication, and complications costs were taken from publications. All costs were calculated in Chinese yuan (CNY) and discounted to 2022. The long-term outcomes estimated by the model spanned 40 years and encompassed life years (LY), quality-adjusted life years (QALY), cumulative incidence of diabetes-related complications, time alive and free of complication, costs, incremental cost-effectiveness ratio (ICER), and a probabilistic sensitivity analysis.

IDegLira was associated with increased LY (12.46 vs 12.413), increased QALY (10.946 vs 10.669), and reduced costs (CNY408,580.94 [USD56,407.22] vs CNY586,937.81 [USD81,030.54]) compared to basal-bolus insulin therapy. IDegLira was dominant compared to basal-bolus insulin therapy and exhibited a reduction in the cumulative incidence of diabetes-related complications. Additionally, IDegLira extended the time alive and free of complications. The probabilistic sensitivity analysis showed with 100 percent accuracy that IDegLira is more cost effective as compared to basal-bolus insulin therapy.

Based on this analysis, IDegLira can be fully regarded as a dominant treatment compared to basal-bolus insulin therapy in Chinese patients with uncontrolled T2DM on basal insulin.

China has a high incidence of birth defects. Tandem mass spectrometry (MS/MS) screening enables rapid detection of multiple inherited metabolic disorders and has been widely promoted globally. This study aimed to conduct a budget impact analysis of replacing phenylketonuria screening with MS/MS by calculating the financial impact of reimbursing the costs of MS/MS screening.

An Excel-based budget impact analysis model for MS/MS screening was developed. The number of newborns in Shanghai from 2024 to 2026 was estimated using the birth rate trend among the permanent population of Shanghai over the past decade. By integrating clinical screening data, along with the corresponding screening costs and diagnostic fees for the gold standard test, the financial impact of replacing phenylketonuria screening with MS/MS screening was calculated. The screening data for this study was extracted from a tertiary hospital in Shanghai. Demographic data were obtained from statistical websites, while cost data were derived from literature and a tertiary hospital in Shanghai.

The fiscal expenditures for phenylketonuria screening were CNY1.75 million (USD0.25 million), CNY1.65 million (USD0.23 million), and CNY1.56 million (USD0.22 million) for 2024, 2025, and 2026, respectively. In contrast, the corresponding fiscal expenditures for MS/MS were CNY25.23 million (USD3.54 million), CNY23.78 million (USD3.33 million), and CNY22.41 million (USD3.14 million). The additional fiscal expenditure for MS/MS, compared with phenylketonuria screening, was CNY23.48 million (USD3.29 million), CNY22.13 million (USD3.10 million), and CNY20.85 million (USD2.92 million), showing a yearly decreasing trend.

The financial impact of MS/MS screening was controllable. It was recommended that the cost of MS/MS screening in Shanghai be covered by government funding. The promotion of newborn screening using MS/MS deserves priority consideration and publicity in Shanghai, China.

Treatment with atezolizumab plus standard chemotherapy can prolong the overall survival of patients with metastatic non-squamous non-small cell lung cancer (NSCLC). However, the economic value of this treatment regimen is unknown. This study aimed to estimate the cost effectiveness of atezolizumab plus chemotherapy in the first-line treatment of metastatic non-squamous NSCLC from a healthcare system perspective in China.

A partitioned survival model consisting of three discrete health states was developed to estimate the cost and effectiveness of atezolizumab plus carboplatin or cisplatin plus pemetrexed (APP) versus carboplatin or cisplatin plus pemetrexed (PP) in the first-line treatment of metastatic non-squamous NSCLC over a 12-year lifetime horizon. Key clinical data were generated from the IMpower132 trial. Local direct medical and non-medical costs were used and health preference data were collected from patients with NSCLC in 13 tertiary hospitals across five provinces in China. Costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured. One-way and probabilistic sensitivity analyses were performed to assess the robustness of the model.

Compared with the PP regimen, APP therapy yielded a gain of 0.21 QALYs at an increased cost of CNY145,602 (USD22,574), resulting in an ICER of CNY684,894 (USD106,185) per QALY gained. The ICER was significantly higher than three times the gross domestic product per capita for China in 2021 (USD37,663). One-way sensitivity analyses revealed that one of the most influential factors in this model was the cost of atezolizumab. Probabilistic sensitivity analysis showed that there was 14.7% probability that atezolizumab plus chemotherapy was cost effective at a willingness-to-pay value of CNY242,928 (USD37,663) per QALY gained.

The APP regimen could prolong survival and improve health benefits over standard chemotherapy in the first-line treatment of patients with metastatic non-squamous NSCLC, but it is unlikely to be a cost-effective treatment option in China.

Sintilimab is an IgG4 anti-programmed cell death protein 1 (PD-1) antibody that has a high-affinity blocking interaction with PD-1 and its ligands. The updated ORIENT-11 study showed that sintilimab plus chemotherapy significantly prolonged progression-free and overall survival, compared with chemotherapy alone, in the first-line treatment of non-squamous non-small cell lung cancer (NSCLC). In China, it is uncertain whether sintilimab is a cost-effective alternative to standard immunotherapy.

A partitioned survival model with three health states (including progression-free survival, disease progression, and death) was constructed from the Chinese societal perspective using a three-week cycle with a lifetime horizon (16 years). Individual patient data were captured from the updated ORIENT-11 study, and high-risk and clinically severe adverse events were specifically added to the states. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were the primary outcomes. Costs, health productivity losses, and utilities were derived from questionnaires and supplemented by expert opinion and literature review. All costs were expressed in 2021 USD, and costs and QALYs were discounted at an annual rate of five percent. Sensitivity analyses and scenario analyses considering the healthcare system perspective were performed to explore model uncertainty.

Patients receiving sintilimab plus chemotherapy incurred a mean total cost of USD67,727 and gained 2.5 QALYs during the lifetime period, compared with USD40,530 and 1.5 QALYs for patients receiving standard chemotherapy. The corresponding ICER was USD27,665 per QALY in China. At a willingness-to-pay threshold of three times the gross domestic product per capita in China (USD37,663), sintilimab plus chemotherapy was the optimal treatment in 84 percent of replications. Deterministic sensitivity analysis showed that the most significant driving determinant was the discount rate of costs and QALYs. An ICER of USD21,020 per QALY was obtained from the Chinese healthcare system, validating the robustness of the cost-effectiveness analysis.

Compared with standard chemotherapy, sintilimab plus chemotherapy is a cost-effective treatment regimen for non-squamous NSCLC in China. Thus, sintilimab may benefit Chinese patients and should be promoted by decision makers.