Cost-Effectiveness Analysis of Serplulimab Combined with Nab-Paclitaxel Plus Carboplatin Compared to Nab-Paclitaxel Plus Carboplatin Alone as First-Line Treatment for Advanced Squamous Non-Small Cell Lung Cancer in China

Purpose: The ASTRUM-004 trial demonstrated the efficacy of serplulimab combined with nab-paclitaxel plus carboplatin chemotherapy in untreated patients with advanced squamous non-small cell lung cancer (NSCLC). Our study aimed to evaluate the costeffectiveness of this combination therapy compared to that of nab-paclitaxel plus carboplatin chemotherapy alone for advanced squamous NSCLC patients from the perspective of the Chinese healthcare system. Patients and Methods: A partitioned survival model based on the survival data of the ASTRUM-004 trial was constructed to assess the cost-effectiveness. The direct medical costs and utilities were derived from published literature and real-world medical institutions. The total costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated. Sensitivity analyses and scenario analyses were conducted to assess the robustness of the model. Results: The base-case analysis revealed that serplulimab combined with nab-paclitaxel plus carboplatin chemotherapy provided 0.53 incremental QALYs at an incremental cost of $60,790.77, with an ICER of $114,207.24/QALY. The ICER significantly exceeded the Chinese willingness-to-pay threshold ($37,743.79/QALY). Body weight, the utility value of progression-free survival stage, and the price of serplulimab were the main influencing factors of the ICER. Probabilistic sensitivity analysis revealed that there was no possibility of cost-effectiveness under the current threshold. Scenario analyses revealed that this combination therapy would only be cost-effective if the price of serplulimab fell by at least 80.3%. Conclusion: Compared to nab-paclitaxel plus carboplatin chemotherapy alone, serplulimab combined with nab-paclitaxel plus carboplatin chemotherapy might not be economical for advanced squamous NSCLC patients in China under current pricing conditions. This study suggests that future price reductions for serplulimab could make this therapy more economically viable and provide guidance for drug pricing decisions.