Cost-effectiveness of benmelstobart and anlotinib plus chemotherapy as first-line therapy for extensive-stage small cell lung cancer in China

The results of the ETER701 trial showed that benmelstobart and anlotinib plus chemotherapy have potential advantages in the treatment of extensive small cell lung cancer (ES-SCLC). However, it must be noted that the high cost cannot be ignored. This study was designed to assess the cost-effectiveness of benmelstobart (B) and anlotinib (A) plus etoposide and carboplatin (EC) as first-line treatment options for patients with ES-SCLC in China. From the perspective of Chinese healthcare system, a three-state partitioned survival model was employed. The cycle length was set at three weeks, and the time horizon of the study was set as lifetime horizon. Total costs, life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) as primary outputs of the model. Among them, the cost, and utility values were respectively derived from the YAOZHI database, and published literature on the subject. At the same time, in order to assess the impact of parameter uncertainty on the model outputs, scenario and sensitivity analyses were carried out. The results showed that compared with the EC group, the ICER for the B + A + EC group was $141,623.44/QALY, and the ICER for the A + EC group was $45,353.46/QALY, which were both higher than the willingness-to-pay (WTP) threshold ($38,024.68/QALY). Sensitivity analysis verified the robustness of the model. Scenario analysis showed that charitable donations and cut-price could raise the likelihood of being cost-effective for benmelstobart and anlotinib. B + A + EC and A + EC are considered unlikely to be cost-effective strategies for first-line treatment of ES-SCLC in China. However, reducing the costs of benmelstobart and anlotinib may enhance the cost-effectiveness of these treatment regimens.