Camrelizumab in patients with advanced non-squamous non-small cell lung cancer: a cost-effective analysis in China

Abstract

Objective: Camrelizumab is a selective, humanised, high-affinity IgG₄ kappa monoclonal antibody against programmed cell death 1 that shows effective antitumour activity with acceptable toxicity in multiple tumour types. The CameL trial demonstrated that camrelizumab plus chemotherapy (CC) significantly prolonged the median progression-free survival and median overall survival versus chemotherapy alone (CA) in patients with advanced non-squamous non-small cell lung cancer (NSCLC). Our study was conducted to investigate the cost-effectiveness of the two strategies in chemotherapy-naive patients with advanced non-squamous NSCLC.

Design, setting and participants: A Markov simulation model was generated based on the CameL trial. The two simulated treatments included CC and CA.

Primary and secondary outcome measures: Utility was derived from published literature, and costs were calculated based on those at our hospital in Chengdu, China. Incremental cost-effectiveness ratios (ICERs) were calculated to compare the cost-effectiveness of the two treatment arms.

Results: In the overall population, the total costs were $27 223.40 and $13 740.10 for CC and CA treatment, respectively. The CC treatment produced 1.37 quality-adjusted life years (QALYs), and the CA treatment produced 1.17 QALYs. Hence, patients who were in the CC group spent an additional $13 483.30 and generated an increase of 0.20 QALYs, resulting in an ICER of $67 416.50 per QALY.

Conclusions: For chemotherapy-naive patients with advanced non-squamous NSCLC, CC is not considered a cost-effective treatment versus CA in China when considering a willingness-to-pay threshold of $31 500 per QALY.

Trial registration number: NCT03134872.

Keywords: CHEMOTHERAPY; HEALTH ECONOMICS; Health economics; Respiratory tract tumours.

Figure 1

A Markov structure was built to compare two treatment strategies. PD, progressive disease; PFS, progression-free survival.

Figure 2

The original Kaplan-Meier PFS (A) and OS (B) curves from the CameL trial. Weibull distributions were fitted to the two groups. CA, chemotherapy alone; CC, camrelizumab plus chemotherapy; OS, overall survival; PFS, progression-free survival.

Figure 3

Tornado diagram of one-way sensitivity analyses. The impact of parameters on the ICER was listed. AEs, adverse events; BSA, body surface area; Cam, camrelizumab; ICER, incremental cost-effectiveness ratio; PC, pemetrexed+carboplatin; PD, progressive disease; PFS, progression-free survival.

Figure 4

The cost-effectiveness acceptability curve showed the probability at different WTP thresholds. Cam, camrelizumab; PC, pemetrexed+carboplatin; WTP, willingness-to-pay.

Figure 5

The dashed line indicates the WTP threshold. All of the scatter points are located above the WTP threshold, implying that camrelizumab plus chemotherapy is not a cost-effective therapy at the current WTP. WTP, willingness-to-pay.