Cost-Effectiveness Analysis of Penpulimab Plus Paclitaxel and Carboplatin Combination Therapy As First-Line Therapy for Advanced or Metastatic Squamous Non-Small-Cell Lung Cancer

OBJECTIVES: Lung cancer is the leading cause of mortality related to carcinoma in China. Penpulimab is a PD-1 monoclonal antibody recommended for squamous non-small cell lung cancer (sqNSCLC) in combination with paclitaxel and carboplatin. This study aimed to assess the cost-effectiveness of penpulimab plus paclitaxel and carboplatin versus paclitaxel plus carboplatin for first-line treatment in patients with advanced or metastatic sqNSCLC in China.

METHODS: A three-state partitioned survival model was conducted using the efficacy outcomes obtained by digitizing the AK105-302 clinical trial and extrapolated to the lifetime horizon. Direct medical costs and utilities were collected from literature and commercial databases at the Chinese payer perspective. Outcomes included life-years (LYs), quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER). One-way sensitivity analysis, probabilistic sensitivity analysis and scenario analysis were performed to test model robustness.

RESULTS: In the base-case analysis, the incremental efficacy of penpulimab plus paclitaxel and carboplatin was 1.02 QALYs and 1.59 LYs with an incremental cost of $33,697 compared with paclitaxel plus carboplatin combination therapy. The ICER was $32,892/QALY and lower than three times China's per capita GDP, a commonly used threshold. The results of the one-way sensitivity analysis showed that ICER values were most sensitive to the utility of progression-free state and the price of penpulimab. Probabilistic sensitivity analysis showed that penpulimab plus paclitaxel and carboplatin was cost-effective in 83.4% of the cases. Scenario analysis yielded similar results as base-case analysis.

CONCLUSIONS: Penpulimab plus paclitaxel and carboplatin combination therapy is cost-effective for patients with advanced or metastatic squamous non-small-cell lung cancer in China.