ArticleFrontiers in public health2026
Cost-effectiveness analysis of combined immunotherapy regimens for non-squamous non-small lung cancer after tyrosine kinase inhibitors resistance.
Article in Frontiers in public health, 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
Background: Immunotherapy combined with anti-angiogenic agents and chemotherapy has emerged as a novel therapeutic option for non-squamous non-small cell lung cancer (non-sqNSCLC) after resistance to tyrosine kinase inhibitors (TKIs). This study evaluated the efficacy, safety, and cost-effectiveness of these regimens in patients with TKI-resistant non-sqNSCLC in China. Methods: A network meta-analysis was performed to compare the efficacy and safety of ivonescimab plus chemotherapy (Ivon-Chem), sintilimab plus bevacizumab and chemotherapy (Sint-Beva-Chem), and atezolizumab plus bevacizumab and chemotherapy (Atez-Beva-Chem). A Markov model was constructed to assess the cost-effectiveness of Ivon-Chem, Sint-Beva-Chem, Atez-Beva-Chem, and chemotherapy until the survival probability fell below 1% in any regimen. The incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) were estimated using a willingness-to-pay (WTP) threshold of $41,859. Sensitivity analyses and scenario simulations were also performed. Results: Ivon-Chem, Sint-Beva-Chem, and Atez-Beva-Chem improved efficacy but were associated with poorer safety profiles than chemotherapy. Compared with chemotherapy, Ivon-Chem, Sint-Beva-Chem, and Atez-Beva-Chem were not cost-effective, with ICERs of $61,882.3/QALY, $68,657.0/QALY, and $188,820.5/QALY, respectively. Moreover, the NMBs of Ivon-Chem, Sint-Beva-Chem and Atez-Beva-Chem were all negative, indicating that none of these regimens was economically acceptable. Scenario analyses indicated that, compared with chemotherapy, Ivon-Chem would become cost-effective if the price of ivonescimab were reduced by at least 47.2%. Similarly, Sint-Beva-Chem and Atez-Beva-Chem would achieve cost-effectiveness following price reductions of 59.3% for both sintilimab and bevacizumab, and 84.4% for both atezolizumab and bevacizumab, respectively. Conclusion: These immunotherapy-based regimens provided significant survival benefits in patients with TKI-resistant non-sqNSCLC. However, from the perspective of the Chinese healthcare system, Ivon-Chem, Sint-Beva-Chem, and Atez-Beva-Chem were not cost-effective. Substantial price reductions would be required to improve their economic viability.
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