Comparative cost-effectiveness of sintilimab, toripalimab, and camrelizumab in first-line therapy for advanced non-squamous non-small cell lung cancer.

Background: Several PD-1 inhibitors used in first-line treatment of advanced non-squamous non-small cell lung cancer in China, including sintilimab, toripalimab and camrelizumab, have demonstrated significant survival benefits in phase III trials. However, their comparative cost-effectiveness within the Chinese national medical insurance system remains unclear. Methods: A Markov model with progression-free, progressive disease and death states was developed from the Chinese national medical insurance system payer perspective. Clinical efficacy inputs were obtained from three China-based phase III randomized trials. Individual patient data were reconstructed from published Kaplan-Meier curves using the Guyot method, and parametric survival models were fitted for extrapolation. Costs included drug acquisition, administration, adverse event management and post-progression therapy. Outcomes were total costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). One-way and probabilistic sensitivity analyses were conducted. Results: Sintilimab incurred the lowest cost (230,813 CNY) and generated 1.1 QALYs. Toripalimab yielded the same QALYs at a higher cost and was strictly dominated. Camrelizumab produced the highest QALYs (1.2) at a total cost of 253,056 CNY. Compared with sintilimab, camrelizumab had an ICER of 164,983 CNY/QALY, below the willingness-to-pay threshold of 287,247 CNY/QALY. Sensitivity analyses confirmed the robustness of these findings. Conclusion: Among the three domestic PD-1 inhibitors evaluated, camrelizumab is the most cost-effective first-line treatment option for advanced non-squamous NSCLC in China.