Drug Pricing of Domestic Anti-PD-L1 Antibody Adebrelimab: Cost-Effectiveness Analysis of the First-Line ES-SCLC Treatment in China

Figures & data

Figure 1 Markov model diagram. ES-SCLC extensive stage-small-cell lung cancer, AEP adebrelimab combined with etoposide and platinum, EP etoposide plus platinum.

Table 1 Summary of Simulation Results

Population	HRs for AEP vs EP		Incremental QALY for AEP vs EP	Incremental Cost for AEP vs EP, $US^a	ICER for AEP vs EP, $/QALY^b	Price Ceiling of Adebrelimab/mg that Renders AEP Cost-Effective, Mean (95% CI), $US	Cost Ceiling of Adebrelimab/Cycle that Renders AEP Cost-Effective, Mean (95% CI), $US
	OS	PFS
Entire patient population	0.72	0.67	0.312	3501 to 67,437	11,236 to 216,409	0.542 (0.542–0.552)	705 (704–717)
Subgroups
Male	0.72	0.72	0.284	3474 to 64,019	12,230 to 225,525	0.502 (0.501–0.510)	652 (651–664)
Female	0.62	0.55	0.457	5627 to 65,122	12,305 to 142,409	0.820 (0.812–0.826)	1,066 (1,055–1,073)
Age <65 years	0.71	0.70	0.299	3667 to 61,057	12,245to 204,225	0.557 (0.550–0.560)	724 (714–728)
Age ≥65 years	0.70	0.62	0.318	3490 to 64,790	10,969 to 203,652	0.583 (0.579–0.588)	758 (752–765)
ECOG performance status score of 0	0.83	0.62	0.157	246 to 61,545	1567 to 391,143	0.390 (0.386–0.393)	507 (502–511)
ECOG performance status score of 1	0.69	0.69	0.329	4206 to 62,044	12,784 to 188,568	0.596 (0.594–0.605)	774 (772–786)
Current or former smoking	0.75	0.76	0.242	2837 to 57,811	11,719 to 238,828	0.481 (0.476–0.486)	625 (619–631)
Never smoking	0.59	0.44	0.530	5445 to 79,863	10,269 to 150,617	0.821 (0.817–0.830)	1,068 (1,063–1,079)
LDH concentration ≤ULN	0.59	0.7	0.506	7843 to 65,241	15,485 to 128,813	0.824 (0.815–0.830)	1,071 (1,059–1,079)
LDH concentration >ULN	0.83	0.64	0.156	377 to 60,615	2,414 to 388,424	0.384 (0.380–0.387)	500 (494–503)
With liver metastasis	0.92	0.74	−0.068	−54,957 to 780	−11,494 to 810,306	0.252 (0.250–0.256)	327 (325–333)
Without liver metastasis	0.61	0.64	0.470	6699 to 66,941	14,265 to 142,540	0.768 (0.763–0.776)	998 (992–1,099)
Without brain metastasis	0.68	0.65	0.347	4295 to 64,028	12,389 to 184,687	0.661 (0.659–0.671)	803 (802–815)
IV stage disease	0.72	0.68	0.286	3272 to 61,564	11,448 to 215,346	0.541 (0.538–0.548)	703 (700–712)
PD-L1 expression <1%	0.66	0.68	0.377	5116 to 63,409	13,560 to 168,055	0.657 (0.650–0.662)	854 (845–861)
PD-L1 expression ≥%	0.72	0.70	0.285	3376 to 60,771	11,852 to 213,366	0.539 (0.537–0.547)	701 (698–711)

Notes: ^aThe range of incremental costs corresponds to the variation in ICER values when the price of adebrelimab/mg was adjusted from 0 to 4.21$ during the base-case analysis (price simulation analysis), while maintaining other parameter values at their baseline levels. ^bThe range of ICER corresponds to the variation in ICER values when the price of adebrelimab/mg was adjusted from 0 to 4.21$ during the base-case analysis (price simulation analysis), while maintaining other parameter values at their baseline levels.

Abbreviations: HRs, hazard rations; AEP, adebrelimab combined with etoposide and platinum; EP, etoposide plus platinum; ICER, incremental cost-effectiveness ratios; DSA, deterministic sensitivity analysis; QALY, quality-adjusted life-year; CI, Confidence Interval; ECOG, Eastern Cooperative Oncology Group; LDH, lactate dehydrogenase; ULN, upper normal limit; PD-L1, programmed cell death ligand-1.

Figure 2 The relationship between the price of adebrelimab/mg and ICER of first-line AEP versus first-line EP. The intersection of the red straight line and other slashes represent the price ceiling of adebrelimab/mg that makes the first-line AEP cost-effective compared with the first-line EP.

Abbreviations: AEP, adebrelimab combined with etoposide and platinum; EP, etoposide plus platinum; ECOG, Eastern Cooperative Oncology Group; LDH, lactate dehydrogenase; ULN, upper normal limit; ES-SCLC, extensive stage-small-cell lung cancer; PD-L1, programmed cell death ligand-1.