Hongting Yao,1 Kai Xu,1 Man Yu,1 Xiaoye Wang,2 Yingzhi Lu,3 Xin Li,1,2,4,5 Hong Wu6 

1Department of Pharmaceutical Regulatory Science and Pharmacoeconomics, School of Pharmacy, Nanjing Medical University, Nanjing, People’s Republic of China; 2Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing, People’s Republic of China; 3Department of Oncology, The Second People’s Hospital of Lianyungang (Lianyungang Tumor Hospital), Lianyungang, People’s Republic of China; 4Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, People’s Republic of China; 5Department of Pharmacy, The Second People’s Hospital of Changzhou, The Third Affiliated Hospital of Nanjing Medical University, Changzhou, People’s Republic of China; 6Department of Pharmacy, The Second People’s Hospital of Lianyungang, Lianyungang, People’s Republic of China

Correspondence: Hong Wu, Department of Pharmacy, The Second People’s Hospital of Lianyungang, No. 41 Hailian East Road, Haizhou District, Lianyungang, Jiangsu, 222000, People’s Republic of China, Email jiangsuwuhong163@163.com Xin Li, School of Pharmacy, Nanjing Medical University, No. 101 Longmian Avenue, Jiangning District, Nanjing, Jiangsu, 211166, People’s Republic of China, Email xinli@njmu.edu.cn

Purpose: The ASTRUM-004 trial demonstrated the efficacy of serplulimab combined with nab-paclitaxel plus carboplatin chemotherapy in untreated patients with advanced squamous non-small cell lung cancer (NSCLC). Our study aimed to evaluate the cost-effectiveness of this combination therapy compared to that of nab-paclitaxel plus carboplatin chemotherapy alone for advanced squamous NSCLC patients from the perspective of the Chinese healthcare system.
Patients and Methods: A partitioned survival model based on the survival data of the ASTRUM-004 trial was constructed to assess the cost-effectiveness. The direct medical costs and utilities were derived from published literature and real-world medical institutions. The total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. Sensitivity analyses and scenario analyses were conducted to assess the robustness of the model.
Results: The base-case analysis revealed that serplulimab combined with nab-paclitaxel plus carboplatin chemotherapy provided 0.53 incremental QALYs at an incremental cost of $60,790.77, with an ICER of $114,207.24/QALY. The ICER significantly exceeded the Chinese willingness-to-pay threshold ($37,743.79/QALY). Body weight, the utility value of progression-free survival stage, and the price of serplulimab were the main influencing factors of the ICER. Probabilistic sensitivity analysis revealed that there was no possibility of cost-effectiveness under the current threshold. Scenario analyses revealed that this combination therapy would only be cost-effective if the price of serplulimab fell by at least 80.3%.
Conclusion: Compared to nab-paclitaxel plus carboplatin chemotherapy alone, serplulimab combined with nab-paclitaxel plus carboplatin chemotherapy might not be economical for advanced squamous NSCLC patients in China under current pricing conditions. This study suggests that future price reductions for serplulimab could make this therapy more economically viable and provide guidance for drug pricing decisions.

Keywords: cost-effectiveness, serplulimab, squamous non-small cell lung cancer, ASTRUM-004 trial