ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1669965
Immune Checkpoint blockers plus Chemotherapy as the First-Line Treatment for advanced or metastatic Squamous Non-small cell lung carcinoma: A Network Meta-Analysis and Economic Evaluation
Provisionally accepted
- 1Shanghai Second People’s Hospital, Shanghai, China
- 2Shanghai Changning Maternity and Infant Health Hospital, Shanghai, China
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Objective: Immune checkpoint inhibitors (ICIs) combined with chemotherapy have shown significant survival benefits in advanced squamous non-small cell lung cancer (NSCLC), as confirmed by clinical guidelines. However, the high cost of ICIs imposes a substantial economic burden on patients. An economic evaluation of various ICI plus chemotherapy regimens is urgently needed. This study assessed the cost-effectiveness of several regimens for advanced squamous NSCLC from the perspective of the Chinese healthcare systempayer. Methods: A network meta-analysis (NMA) was conducted to compare the efficacy of different ICI plus chemotherapy regimens. Key outcomes, including hazard ratios for overall survival (OS) and progression-free survival (PFS), were extracted from clinical trials. A cost-utility analysis was performed. Results: Data from six clinical trials involving 2,548 patients were analyzed. Camrelizumab plus chemotherapy and penpulimab plus chemotherapy regimen showed the greatest OS benefit, while the camrelizumab plus chemotherapy provided the best PFS benefit. The tislelizumab plus chemotherapy regimen offered the lowest treatment costs ($42,882.3) and the Incremental cost-utility ratio (ICUR) is $ 4,062.0/ per quality-adjusted life-year (QALY). The camrelizumab plus chemotherapy regimen offered the highest survival benefit (2.344 QALYs) and the ICUR is $ 6,078.4/QALY. And the ICUR of penpulimab plus chemotherapy regimen is $25,712.3/QALY. The ICURs of other three ICI plus chemotherapy regimens were higher than the willingness to pay threshold. Conclusions: Among the six ICI plus chemotherapy regimens evaluated, tislelizumab plus chemotherapy demonstrated the lowest ICUR, followed by camrelizumab plus chemotherapy regimen. However, with the threshold of $13,445/QALY or $40,334/QALY, camrelizumab plus chemotherapy provided greater QALY benefits than tislelizumab plus chemotherapy. Thus, camrelizumab plus chemotherapy is recommended as the preferred first-line treatment for advanced squamous non-small cell lung cancer in this context.
Keywords: immune checkpoint inhibitors plus chemotherapy, Squamous non-small cell lung cancer, Network meta-analysis, economic evaluation, Chinese perspective
Received: 21 Jul 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Lang, Yang and Cao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yitian Lang, sci-yitianlang@outlook.com
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