Cost-effectiveness of anlotinib vs. pembrolizumab and nivolumab as third-line treatment in recurrent small cell lung cancer in China

ABSTRACT

Background

The study aims to evaluate the cost-effectiveness of anlotinib versus pembrolizumab and nivolumab as the third-line treatment in recurrent small cell lung cancer (SCLC) patients from the Chinese healthcare system perspective.

Research design and methods

A Markov model was built to simulate the costs and health outcomes in the 4-year horizon. Efficacy and safety data of anlotinib, pembrolizumab, and nivolumab in patients with recurrent SCLC were derived from three studies. Cost and utility values were derived from local charges, the published literature, and related databases. Three scenario analyses and sensitivity analyses were performed to explore the robustness of the results.

Results

Compared with anlotinib, pembrolizumab and nivolumab were estimated to gain an additional 0.18 and 0.10 quality-adjusted life years (QALYs) at an incremental cost of $10,446 and $5,182, resulting in an increment cost-utility ratio (ICUR) of $58,221/QALY and $56,733/QALY. The sensitivity analyses showed that the likelihood of anlotinib being cost-effective was 87.5% to 99.9% at a willingness-to-pay (WTP) threshold of $11,144 to $33,431/QALY. The scenario analyses indicated that the results varied in different scenarios.

Conclusions

The findings suggest that anlotinib could be the most cost-effective option versus pembrolizumab and nivolumab in the third-line treatment of recurrent SCLC from the Chinese healthcare system perspective.

KEYWORDS:

• Anlotinib
• China
• cost-effective
• long-term survival
• nivolumab
• pembrolizumab
• small cell lung cancer

Key points for decision makers

Anlotinib appears to be more cost-effective compared with pembrolizumab and nivolumab as the third-line treatment in recurrent SCLC in China. However, due to the lack of sufficient data, the most cost-effectiveness option varied greatly in different scenarios.

Pembrolizumab and nivolumab are found to bring more long-term survival benefit than anlotinib, even though these two regimens as the third-line treatment for patients with recurrent SCLC in China are off-label use.

Availability of data and material

All the data input in the model are available in within the manuscript and the electronic supplementary material.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Z Fei and M Rui contribute equally to the completion of the study. Z Fei and M Rui were responsible for the study design and model construction. Z Fei and Y Wang contributed to the data collection and manuscript writing. A Ma checked and revised the manuscript. All authors approved the final manuscript to be published.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2144837

Additional information

Funding

This paper was not funded.