Introduction: The Economic Impact of Lung Cancer in China

Lung cancer, the leading cause of cancer-related deaths in China, imposes a staggering economic burden. Recent studies highlight the dire financial implications, with estimates soaring to US$1.2 trillion in economic damages by 2050. The treatment of small cell lung cancer (SCLC), comprising 13-17% of lung cancer cases, remains a challenge due to late-stage diagnoses and high relapse rates. The quest for cost-effective therapies is paramount, with immune checkpoint inhibitors (ICIs) like adebrelimab emerging as an option to relieve the pressure.

The Promise of Adebrelimab: A Step Forward in Survival Rates

Adebrelimab, China’s first self-developed PD-L1 inhibitor, has significantly altered the treatment landscape for extensive-stage (ES)-SCLC. Clinical trials have demonstrated its efficacy in extending median overall survival and reducing mortality risk. There is a 27% reduction in risk of death and 21.1% survival rate at 3 years. With China’s National Medical Products Administration’s approval, adebrelimab in combination with chemotherapy is now a first-line treatment option. However, the question of its cost-effectiveness remains unanswered.

Cost-Effectiveness of Adebrelimab

The cost-effectiveness of medical treatments is a critical consideration in the sustainable allocation of healthcare resources. A recent study evaluated adebrelimab’s cost-effectiveness, revealing that despite its clinical benefits, the current pricing structure does not present an economically viable option. The average incremental cost-effectiveness ratio (ICER) of US$138 582/QALY far exceeds the willingness to pay (WTP) thresholds (range between US$100 000/QALY and US$150 000/QALY) recommended in China, suggesting the need for price negotiations and a re-evaluation of WTP criteria for innovative treatments.

Exploring Price and Time Horizon Influences on Cost-Effectiveness

The sensitivity analysis of this study underscored the profound impact of adebrelimab’s price on its cost-effectiveness. Even with significant price reductions, around 85%, the therapy’s ICER remained above the acceptable WTP threshold. The study also unpacked the effects of varying time horizons (TH) on ICER, revealing that longer THs could potentially lower the ICER due to the ‘delayed effect’ of ICIs.

Comparing Adebrelimab with Alternative Therapies

In real-world scenarios, stakeholders are often faced with choosing between drugs with similar mechanisms of action. This study compared the cost-effectiveness of adebrelimab with serplulimab, another PD-L1 inhibitor, concluding that adebrelimab was less economical. The small difference in QALYs between the two therapies led to a higher ICER for adebrelimab.

Methodological Considerations in Survival Analysis

The choice of statistical methods for survival analysis significantly influences economic evaluations. This study utilised various models to extrapolate survival curves, acknowledging that while some models may underestimate the efficacy of immunotherapy, others may provide a more accurate fit when survival data are mature. Regardless of the model chosen, adebrelimab’s cost-effectiveness was consistently not demonstrated.

Conclusions: The Verdict on Adebrelimab’s Economic Viability

From the healthcare system’s perspective in China, the addition of adebrelimab to chemotherapy for the treatment of ES-SCLC is not cost-effective under the current pricing framework. Findings underscore the need for strategic pricing and reimbursement discussions to ensure that innovative treatments like adebrelimab can be sustainably integrated into clinical practice.