Economics of First-line Treatment with Tislelizumab in Patients with Nonsquamous Non-small Cell Lung Cancer: A Four-state Markov Model

Abstract Background Tislelizumab combined with chemotherapy has demonstrated significant clinical benefits as a first-line treatment for patients with nonsquamous non-small cell lung cancer (nsq-NSCLC). This study aimed to evaluate its cost-effectiveness from the perspective of the Chinese healthcare system. Methods A dynamic four-state Markov model was adapted to China’s settings to project health outcomes and costs over a lifetime horizon. Model health states included progression-free survival (PFS), progressive disease state (PDS), terminal progressive disease (TPD) or death. Clinical data for tislelizumab were sourced from a multicenter, open-label, randomized phase III clinical trial conducted at 47 research sites in China. Quality-adjusted life years (QALYs) served as the primary outcome measure, with incremental cost-effectiveness ratios (ICERs) calculated accordingly. We conducted sensitivity analyses to assess the robustness of the base-case results. Results According to the base-case analysis, compared with chemotherapy alone, tislelizumab combination therapy resulted in an incremental cost per patient of $19,594.75 and an incremental outcome of 1.06 QALYs, yielding an ICER of $18,512.47/QALY. This ICER ($18,512.47/QALY) falls below the willingness-to-pay (WTP) threshold of three times the 2023 per capita gross domestic product (GDP) of China ($36,672.23/QALY), suggesting that tislelizumab is an economically favorable choice. One-way sensitivity analysis and probabilistic sensitivity analysis confirmed the robustness of the base-case results. Conclusion Given that the WTP threshold set at three times the 2023 per capita GDP of China, tislelizumab combination therapy can be considered a cost-effective first-line treatment option for patients with NSCLC.