ArticleHealth economics review2026
Pooled survival and cost-effectiveness analysis of immune checkpoint inhibitors-based for metastatic non-small-cell lung cancer with PD-L1 lower than 1.
Article in Health economics review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis study aims to assess whether immune checkpoint inhibitors (ICIs)-based treatments offer significant survival benefits and economic viability for patients presenting with PD-L1 lower than 1%.
methodsThis exploratory analysis was based on individual patient data from randomized controlled trials (CheckMate-227, CheckMate-9LA, KEYNOTE-189, and KEYNOTE-407). Survival outcomes evaluated for this study were overall survival (OS) and progression-free survival (PFS). Economic evaluations estimated total lifetime costs, incremental cost-effectiveness ratios (ICERs), and incremental net-health benefit (INHB) using the Markov model. The willingness-to-pay (WTP) thresholds were $150,000/quality-adjusted life-year (QALY) for the USA and $36,942/QALY for China.
resultsAmong patients receiving immunotherapy-based treatments (N = 754) relative to those treated with chemotherapy-alone (N = 502), survival outcomes were significantly improved (median OS: 17.0 vs. 12.0 months; hazard ratio [HR]: 0.69; 95% confidence interval [CI]: 0.61-0.78; median PFS: 6.5 vs. 5.5 months; HR: 0.68; 95% CI: 0.60-0.77). The cost-effectiveness analysis found that the ICERs with INHBs for immunotherapy-based versus chemotherapy-alone were $273,440.73/QALY with -1.00 QALYs in the USA and $32,783.93/QALY with 0.89 QALYs in China. Crucially, among ICI-based regimens, nivolumab plus ipilimumab-based (INHB: 0.09 QALYs) and pembrolizumab plus chemotherapy (INHB: 0.17 QALYs) were the most cost-effective options in the USA and China, respectively.
conclusionsFirst-line immunotherapies-based therapy was cost-effective in metastatic NSCLC with PD-1 lower than 1% in China but not in the USA. Nivolumab plus ipilimumab-based was identified as the most favorable first-line immunotherapy in the USA, while pembrolizumab plus chemotherapy was preferred in China.
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