Price trends and affordability of metastatic non–small cell lung cancer drugs in China from 2019 to 2024

Background: The affordability of novel cancer drugs is a determinant of health disparities in China and worldwide. Encouragingly, China has initiated drug regulatory reform and national price negotiation policies since 2015. As a growing number of novel lung-cancer targeted drugs are approved in China, it is expected to improve the affordability of lung cancer targeted drugs. This study aims to assess the monthly treatment cost of approved targeted drugs for metastatic Non–Small Cell Lung Cancer (NSCLC) and the possible impact of within-class drugs in China from 2019 to 2024. Methods: The domestic and imported new therapeutic agents for metastatic NSCLC approved in China between January 1, 2010, and October 1, 2024, were included, using data from the National Medical Products Administration database. We searched the launch and the latest price data between 2019 and 2024 from the procurement platforms of the provincial medical insurance bureau. The main outcome was trends over time in monthly treatment cost and the correlation in cost among the multiple NSCLC agents within each therapeutic class, measured using the Pearson correlation coefficient. We further compared the cost of different medication with the per capita disposable monthly income in China in 2024. The compounded annual growth rates of different medication costs were also assessed. The exchange rate of the U.S. dollar to the Chinese yuan was 7.1 and we adjusted the price based on the annual consumption index published by the National Bureau of Statistics of China given the effect of inflation. Findings: In our cohort study, 30 targeted drugs for metastatic NSCLC were analyzed, including 10 PD1/PDL1 inhibitors, 8 EGFR inhibitors, 6 ALK/ROS inhibitors and 6 MEK/RET inhibitors, respectively. The median monthly treatment of NSCLC drugs on the market at launch (median: $3956; IQR, $2152-$5691) and the latest (median: $1811, IQR, $631-$5450) were significantly higher than the per capita disposable monthly income ($484) in China in 2024. Higher latest monthly treatment costs for PD1/PDL1 (median: $4265, IQR, $518-$6551) and MEK/RET inhibitors (median: $5668, IQR, $5290-8136) were observed. The median Pearson correlation coefficient values were 0.99 (IQR, 0.91-0.99) for PD1/PDL1 inhibitors, 0.92 (IQR, 0.74-0.99) for EGFR inhibitors, 0.73 (IQR, 0.63-0.99) for ALK inhibitors, and 0.97 for MEK and RET inhibitors. The median compounded annual growth rates were -0.98% (IQR, -1.51%, -0.97%) for PD1/PDL1 inhibitors, -26.35% (IQR, -38.17%, -11.50%) for EGFR inhibitors, -30.72% (IQR, -37.45%, -21.67%) for ALK/ROS and -0.49% (IQR, -12.05%, 0%) for MEK/RET inhibitors. The lung-cancer drugs included in national health insurance through negotiation had more significant price reductions (-20.53% vs -1.1%, P<0.0001). Interpretation: The approval of within-class drugs and adjustment of the medical-insurance system had played a crucial role in reducing prices and improving affordability, despite the fact that the costs of lung cancer medications remain higher than the disposable income in China. These findings may serve as a guide for other countries in reducing the burden of cancer drugs.