首页|A network meta-analysis of second-line immune checkpoint inhibitors and docetaxel for advanced non-small cell lung cancer: An economic evaluation from China

A network meta-analysis of second-line immune checkpoint inhibitors and docetaxel for advanced non-small cell lung cancer: An economic evaluation from China

Yunfeng Zhao Fanyu Meng Fenghao Shi Linbo Zhao Yi Zhang Shuang Liu Jianhua Tang

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中国科学院科技论文预发布平台

A network meta-analysis of second-line immune checkpoint inhibitors and docetaxel for advanced non-small cell lung cancer: An economic evaluation from China

Yunfeng Zhao ¹Fanyu Meng ¹Fenghao Shi ²Linbo Zhao ¹Yi Zhang ³Shuang Liu ⁴Jianhua Tang⁵

作者信息

1. Hebei Key Laboratory of Neuropharmacology, Department of Pharmacy, Hebei North University, 11, South Diamond Road, Qiaodong District, Zhangjiakou, Hebei, China
2. International Research Center for Medicinal Administration, Peking University, 38, Xueyuan Road, Haidian District, Beijing, China
3. The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
4. Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450018, China
5. The First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China;School of Disaster and Emergency Medicine, Tianjin University, Tianjin,China
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摘要

研究背景既往研究已对比单药免疫检查点抑制剂（ICIs）与多西他赛的经济学获益，但少有研究结合我国医疗体系，对多款不同免疫检查点抑制剂开展精细化对比。本研究旨在评估纳武利尤单抗、帕博利珠单抗、替雷利珠单抗、阿替利珠单抗四款免疫药物，用于中国晚期非小细胞肺癌（NSCLC）二线治疗时，哪种方案相比多西他赛更具成本效益。研究方法基于 7 项随机对照试验开展网状 Meta 分析，获取无进展生存期（PFS）、总生存期（OS）风险比。经济学评价构建三分区生存模型，采用 Excel 2021 模拟患者 10 年病程，模型循环周期设置为 3 周。本研究从我国医保支付方视角开展分析，仅纳入直接医疗成本；设定支付意愿阈值为 41859 美元 / 质量调整生命年（QALY），该数值等同于 2025 年中国人均国内生产总值（GDP）的 3 倍。为保障模型结果可靠性，本研究同时开展确定性敏感性分析与概率敏感性分析，验证结论稳定性。研究结果四款免疫检查点抑制剂中，替雷利珠单抗可获得最高质量调整生命年（1.160），总花费 21403.22 美元；相较于多西他赛，其增量成本效益比（ICER）最低，为 13718.12 美元 / QALY。其余药物增量成本效益比依次为：纳武利尤单抗 160444.64 美元 / QALY、阿替利珠单抗 231458.82 美元 / QALY、帕博利珠单抗 344114.24 美元 / QALY。单因素敏感性分析证实，药品价格是影响增量成本效益比的最关键参数。概率敏感性分析（PSA）结果显示，在基准支付意愿阈值下，替雷利珠单抗具备成本效益的概率为 100%。研究结论结合我国医疗体系与现行支付意愿标准，替雷利珠单抗是晚期非小细胞肺癌二线治疗中成本效益最优的方案。

Abstract

BackgroundAlthough previous studies have compared the economic benefits of single immune checkpoint inhibitors (ICIs) and docetaxel, few studies have conducted detailed comparisons of different ICIs within China's medical system. This study wanted to see which of the four ICIs-nivolumab, pembrolizumab, tislelizumab and atezolizumab-was more cost-effective than docetaxel when used as second-line treatment for advanced non-small cell lung cancer (NSCLC) in China.MethodsA network meta-analysis was performed based on seven randomized controlled trials to determine hazard ratios for progression-free survival (PFS) and overall survival (OS). The economic assessment built a three-state partitioned survival model, which was done using Excel 2021 to simulate the patient's situation over a period of 10 years, with a cycle every 3 weeks.This analysis is done from the perspective of China's medical insurance payers, including direct medical expenses, using a willingness-to-pay (WTP) threshold of $41,859 per QALY, which is equivalent to three times the per capita GDP of China in 2025. In order to ensure that the model results are reliable, they also performed deterministic sensitivity analysis and probability sensitivity analysis to see if the results were stable.ResultsAmong the four ICIs evaluated, tislelizumab achieved the highest QALYs (1.160) at a cost of $21,403.22, yielding the lowest incremental cost-effectiveness ratio (ICER) of $13,718.12/QALY compared to docetaxel. Nivolumab followed with an ICER of $160,444.64/QALY, Pembrolizumab, and atezolizumab demonstrated ICER of $344,114.24/QALY, and $231,458.82/QALY, respectively. One-way sensitivity analysis identified drug cost as the most influential parameter on the ICER. Probabilistic sensitivity analysis (PSA) confirmed that tislelizumab had a 100% probability of being cost effective at the base WTP threshold.ConclusionFrom the perspective of China's medical system, tislelizumab is the most cost-effective second-line treatment for advanced non-small cell lung cancer based on current willingness to pay benchmarks.

引用本文复制引用

Yunfeng Zhao,Fanyu Meng,Fenghao Shi,Linbo Zhao,Yi Zhang,Shuang Liu,Jianhua Tang.A network meta-analysis of second-line immune checkpoint inhibitors and docetaxel for advanced non-small cell lung cancer: An economic evaluation from China[EB/OL].(2026-07-09)[2026-07-11].https://chinaxiv.org/abs/202607.00106.

学科分类

医学研究方法/肿瘤学

首发时间： 2026-07-09

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