Background Camrelizumab is a selective, humanized, high-affinity IgG4 kappa monoclonal antibody against programmed cell death 1 (PD-1) that shows effective antitumor activity with acceptable toxicity in multiple tumor types. The CameL trial demonstrated that camrelizumab plus chemotherapy significantly prolonged the median progression-free survival (PFS) and median overall survival (OS) versus chemotherapy alone in patients with advanced non-squamous non-small-cell lung cancer (NSCLC). Because of a rapid cancer burden increase in China, our study was conducted to investigate the cost-effectiveness of the two strategies in chemotherapy-naive patients with advanced non-squamous NSCLC.
Methods A Markov simulation model was generated based on the CameL trial. The two simulated treatments included camrelizumab plus chemotherapy (CC) and chemotherapy alone (CA). Utility was derived from published literature, and costs were calculated based on those at our hospital in Chengdu, China. Incremental cost-effectiveness ratios (ICERs) were calculated to compare the cost-effectiveness of the two treatment arms.
Results The total costs were $64,874.51 and $13,531.38 for CC and CA treatment, respectively. The CC treatment produced 1.19 quality-adjusted life years (QALYs), and the CA treatment produced 0.96 QALYs. Hence, patients who were in the CC group spent an additional $51,343.44 and generated an increase of 0.23 QALYs, resulting in an ICER of $223,232.35 per QALY. Currently, in China, CC treatment is not cost-effective when considering a willingness-to-pay (WTP) threshold of $28,130 per QALY gained.
Conclusions For chemotherapy-naive patients with advanced non-squamous NSCLC, camrelizumab plus chemotherapy is not considered a cost-effective therapy versus chemotherapy alone in China.