OBJECTIVES: There is no existing standard treatment for patients with relapsed or refractory follicular lymphoma after at least two prior systemic therapies (3L+ FL) worldwide, whose 5-year overall survival rate is less than 60%. Linperlisib, a highly selective PI3K-δ inhibitor, was firstly approved for 3L+ FL with compelling clinical efficacy in China in 2023. The aim is to evaluate the cost-effectiveness of linperlisib compared to duvelisib, another PI3K inhibitor, from the perspective of China’s healthcare system.

METHODS: A three-health-state partitioned survival model including progression-free survival, post-progression, and death was performed. Patients were modeled with four-week cycles over, for a lifetime horizon. In the absence of head-to-head trials, unanchored matching adjusted indirect comparison (MAIC) was used for survival analyses based on individual patient data from NCT04370405 for linperlisib and aggregate data from NCT01882803 for duvelisib, which accounted for differences in patients’ baseline characteristics between two trials. The utility values were from published literature. The prices of linperlisib and duveliser were both determined based on the national drug price negotiation in 2023. Other medical resource utilizations and costs were estimated by experienced clinicians via in-depth interviews in China. Health outcomes and costs were discounted 5% annually. Outcome measures were reported in incremental cost-effectiveness ratios (ICERs). Both one-way and probabilistic sensitivity analyses were conducted.

RESULTS: In the base-case, linperlisib was associated with an incremental gain of 3.09 life-years and 2.41 quality adjusted life-years (QALYs) compared with duvelisib. And linperlisib also generated ¥155,981 incremental costs, with ¥126,605 from drug costs. The ICER is ¥64,849/QALY, lower than per capita GDP in China (¥85,698, 2022). Additionally, one-way and probabilistic sensitivity analyses proved the robustness of the cost-effectiveness of linperlisib.

CONCLUSIONS: Linperlisib is cost-effective versus duveliser for 3L+ FL patients in China, which was verified in sensitivity analyses. And linperlisib has met an unmet need in China.