Cost-effectiveness analysis of ivonescimab plus chemotherapy in advanced squamous NSCLC: a Chinese healthcare system perspective with U.S. pricing scenario exploration

Background Ivonescimab plus chemotherapy shows outstanding efficacy for advanced squamous non-small cell lung cancer (NSCLC), but its pharmacoeconomic value remains to be determined. Therefore, this study seeks to evaluate the cost-effectiveness of the ivonescimab regimen for advanced squamous NSCLC from the Chinese and U.S. healthcare perspectives, and to explore the theoretical cost-effective price threshold of ivonescimab. Methods Survival curves from the HARMONi-6 trial were fitted and extrapolated, and direct medical costs were calculated. A partitioned survival model was developed within TreeAge Pro to project disease trajectory and resource utilization over a 10-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER), compared against willingness-to-pay (WTP) to assess the ivonescimab regimen’s cost-effectiveness. Sensitivity, scenario, and threshold analyses were performed to assess parameter uncertainty and estimate ivonescimab’s theoretical cost-effective price threshold. Results In China, the ivonescimab group cost $60,942 for 2.33 QALYs versus $30,093 for 1.57 QALYs in the tislelizumab group, yielding an ICER of $40,328/QALY. Utility during progressive disease was the most influential parameter. Ivonescimab’s theoretical cost-effective price thresholds were $27.85/100mg, $67.63/100mg, and $107.4/100mg, corresponding to WTPs of single, double, and triple the per-capita GDP, respectively. In the U.S., the total costs were $572,981 and $419,922, and the health outcomes were 3.16 QALYs and 2.19 QALYs for the two arms, with an ICER of $157,444/QALY. Ivonescimab’s price was the dominant driver of ICER. The theoretical cost-effective price thresholds were $609.10/100 mg and $777.31/100mg, corresponding to the $100,000/QALY and $150,000/QALY WTP, respectively. Conclusion Under the unified model framework of this study, compared with the tislelizumab regimen, the ivonescimab regimen as the first-line treatment for advanced squamous NSCLC in both countries is unlikely to have a cost-effectiveness advantage.