ORIGINAL RESEARCH article
Front. Public Health
Sec. Health Economics
This article is part of the Research TopicReal-World Data and Real-World Evidence in Lung Cancer Volume IIView all 16 articles
Toripalimab as first-line treatment in extensive-stage small cell lung cancer: a health economic evaluation in China
Provisionally accepted
- 1Zhejiang Chinese Medical University, Hangzhou, China
- 2Xuzhou Medical University, Xuzhou, China
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Objective: To assess the cost-effectiveness of toripalimab plus etoposide and platinum-based chemotherapy (EP) as a first-line treatment for extensive-stage small cell lung cancer (ES-SCLC) from a Chinese healthcare perspective, and to explore the impact of factors such as biomarker stratification, drug wastage, and drug donation on cost-effectiveness. Methods: A partitioned survival model was conducted to simulate the disease progression in ES-SCLC patients. Model parameters were derived from the EXTENTORCH clinical trial, public databases, and published literature. Key outcomes included total cost, quality-adjusted life year (QALY), incremental cost-effectiveness ratio (ICER), and incremental net monetary benefit (INMB). Drug wastage was quantified based on body surface area, and patients were stratified according to biomarkers. Sensitivity analysis and scenario analysis were conducted to assess model stability. Results: Over a 10-year simulation period, the total cost of toripalimab plus EP was $28,551.37, with a QALY of 0.75; the total cost of EP was $24,678.81, with a QALY of 0.55. The ICER was $20,034.74/QALY, below China willingness-to-pay threshold of 2-3 times GDP. The sensitivity analysis demonstrated the stability of the conclusions and indicated that when the WTP is set at 2 times the GDP, toripalimab has an 89% probability of being cost-effective. The A11+/B62-genotype and the intratumor heterogeneity (ITH) low population achieve better efficacy and a lower ICER compared to the overall population. While drug wastage increases the treatment cost, it does not alter the conclusions. Conclusions: Compared to EP alone, toripalimab plus EP is cost-effective as first-line treatment in Chinese ES-SCLC patients, particularly when considering genetic stratification and donation policies. The study results provide important reference for China medical insurance policy-making and clinical practice.
Keywords: Health economic evaluation, Extensive-stage small cell lung cancer, PD-1, drug-wastage, biomarkers
Received: 12 Sep 2025; Accepted: 18 Nov 2025.
Copyright: © 2025 Zhu, Li and Wen. 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: Liu Wen, liuwen9295@126.com
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