Cost effectiveness and pricing strategy of first line benmelstobart combination treatment for extensive stage small cell lung cancer in China

The current analysis aimed to evaluate the cost-effectiveness of benmelstobart plus anlotinib and chemotherapy for patients with ES-SCLC from the Chinese health-care system perspective. A mathematical decision model that simulated patients' 3-week transition in 20-year time horizon was conducted to evaluate the economic value. Survival and safety data were gathered from ETER701 trial, cost and utility values were obtained from the local charges and previously published studies. Sensitivity and subgroup analyses were performed to examine the robustness of the model results and to support the health-decision making. For intention-to-treat (ITT) patients, benmelstobart plus anlotinib and carboplatin/etoposide could bring additional 0.60 and 0.71 QALYs with marginal cost of $91,424.86 and $98,504.86 compared with anlotinib plus carboplatin/etoposide and carboplatin plus etoposide, respectively, resulting in an incremental cost-effectiveness ratios (ICERs) were $153,444.29/QALY and $138,272.39/QALY, respectively, which were higher than the Chinese willingness-to-pay (WTP) threshold. Sensitivity analyses and subgroup analyses confirmed the robustness of the model results when parameters changed. Benmelstobart plus anlotinib and carboplatin/etoposide was unlikely to be the cost-effective first-line strategy compared with anlotinib plus carboplatin/etoposide and carboplatin plus etoposide for ES-SCLC patients in China. Reducing the price of benmelstobart could increase its cost-effectiveness.