ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1552734
This article is part of the Research TopicReal-World Data and Real-World Evidence in Lung Cancer Volume IIView all articles
Cost-effectiveness analysis of first-line Tislelizumab plus chemotherapy for extensive-stage small cell lung cancer from the perspective of the healthcare system in China
Provisionally accepted
- 1Department of Respiratory and Critical Care Medicine, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Region, China
- 2School of information and management, Guangxi Medical University, Nanning, Guangxi Zhuang Region, China
- 3Department of pharmacy, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi Zhuang Region, China
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Background: Extensive-stage small-cell lung cancer (ES-SCLC) poses a formidable challenge due to its aggressive nature and poor prognosis. While immune checkpoint inhibitors have shown promise as part of first-line therapy, their cost-effectiveness and survival benefits in the Chinese healthcare system are not well understood.This study evaluates the cost-effectiveness of first-line tislelizumab combined with chemotherapy versus chemotherapy alone for ES-SCLC.We conducted a cost-effectiveness analysis using a partitioned survival mode (PSM) to compare tislelizumab plus chemotherapy versus chemotherapy alone for the first-line treatment of ES-SCLC. The model integrated survival estimates from the RATIONALE-312 Phase III clinical trial, direct medical costs, and quality-adjusted life year (QALY) sourced from the literature. We calculated 10-year cost per QALY gained from Chinese healthcare system perspective.The analysis of cost-effectiveness was benchmarked against a willingness-to-pay threshold three times of GDP per capita in China. Sensitivity analyses were conducted to evaluate parametric uncertainty and model robustness.Results: Compared to the chemotherapy alone group, the tislelizumab plus chemotherapy group resulted in an incremental cost-effectiveness ratio (ICER) of US$31,072.79 per quality-adjusted lifeyear (QALY), which is below the threshold of US$37,765 per QALY. Sensitivity analyses indicated that the utility value of progression-free survival (PFS) is a principal determinant of the ICER, with the ratio fluctuating between $27246 and $36417 per QALY, well below the willingness-to-pay threshold. In scenario analyses, tislelizumab plus chemotherapy resulted in an ICER of US$ 38,665.59/QALY with PET-CT imaging (exceeding the $37,765/QALY threshold) but was cost-effective at US$ 30,076.37/QALY when imported topotecan was used as second-line treatment.Tislelizumab plus chemotherapy demonstrates cost-effectiveness in the first-line treatment of ES-SCLC in China. This study provides preliminary evidence for the economic value of tislelizumab in the treatment of ES-SCLC, supporting its consideration as a first-line therapeutic option.
Keywords: small-cell lung cancer, immune checkpoint inhibitors, cost-effectiveness analysis, tislelizumab, First-line therapy；
Received: 29 Dec 2024; Accepted: 13 May 2025.
Copyright: © 2025 Chen, Feng, Xiao, Tang, Qin, Peng and Bai. 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: Jing Bai, Department of Respiratory and Critical Care Medicine, First Affiliated Hospital, Guangxi Medical University, Nanning, 530021, Guangxi Zhuang Region, China
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