First-line sugemalimab plus chemotherapy for metastatic non-small-cell lung cancer: an updated cost-effectiveness analysis based on 4-year survival data

Abstract

OBJECTIVE: Incorporating the 4‑year long‑term survival outcomes from the GEMSTONE‑302 trial, this study aimed to evaluate the cost‑effectiveness of sugemalimab plus chemotherapy versus chemotherapy alone as first‑line treatment for metastatic non‑small‑cell lung cancer (NSCLC) from the Chinese healthcare perspective. METHODS: A partitioned survival model was developed to simulate cost‑effectiveness outcomes over a 10‑year time horizon. Clinical data were sourced from the GEMSTONE‑302 trial, while costs and health utility values were derived from publicly available sources. The incremental cost‑effectiveness ratio (ICER) was estimated as the primary output. Sensitivity, scenario, and subgroup analyses were performed to assess the impact of uncertainty and heterogeneity on the model results. RESULTS: The base-case ICER for sugemalimab plus chemotherapy versus chemotherapy alone was $84,769.34/QALY, exceeding the willingness-to-pay (WTP) threshold of two times China's 2024 per capita GDP ($26,889/QALY). Sensitivity and subgroup analyses confirmed the robustness of the base‑case results. Scenario analyses revealed that a price reduction or a patient assistance program (PAP) could bring the ICER below the WTP threshold. CONCLUSIONS: Sugemalimab plus chemotherapy may not be a cost-effective option as first-line treatment for metastatic NSCLC compared with chemotherapy, despite its clinical benefits. Implementing a PAP or reducing the price of sugemalimab could improve its cost-effectiveness.