Cost-Effectiveness Analysis of Ivonescimab Plus Chemotherapy versus Tislelizumab Plus Chemotherapy as First-Line Treatment for Advanced Squamous Non-Small Cell Lung Cancer: A Chinese Healthcare Perspective

Lung cancer remains the most common cause of cancer death worldwide, with a specific and aggressive form known as squamous non-small cell lung cancer presenting a particularly difficult challenge. This type of cancer often resists standard treatments because it lacks the specific genetic switches that other drugs target, and its location in the lungs has historically made certain therapies too dangerous due to bleeding risks. For years, the best available option for patients with advanced disease has been a combination of chemotherapy and drugs that help the immune system recognize and attack the tumor. While these treatments have improved survival, many patients still see their disease return or worsen within a few months, leaving doctors and families searching for strategies that offer longer, better-quality lives without placing an impossible financial burden on healthcare systems.

In this context, researchers have been exploring a new type of medicine called a bispecific antibody. Unlike traditional drugs that block just one pathway, these engineered molecules are designed to grab onto two different targets at once: one that helps the immune system fight cancer and another that stops the tumor from building its own blood supply. A recent clinical trial compared this new approach against the current standard of care, showing that the dual-action drug significantly extended the time patients lived without their disease getting worse and also improved their overall survival. However, because this new treatment is more complex and expensive to produce, a critical question remained: does the extra benefit justify the extra cost? To answer this, a team of researchers from Shandong University in China built a detailed computer model to simulate the long-term outcomes and expenses of using this new drug compared to the established treatment, specifically looking at the situation within the Chinese healthcare system.

The researchers constructed a simulation that followed patients over a fifteen-year period, tracking them through three distinct stages of their illness: a time when the cancer was under control, a time when the disease had progressed, and the final stage of life. They fed this model with real data from the HARMONi-6 trial, which had already shown that patients receiving the new drug, ivonescimab, combined with chemotherapy lived longer than those receiving the standard drug, tislelizumab, also combined with chemotherapy. The model calculated not just how many years of life were gained, but also the quality of those years, adjusting for how well patients felt and functioned during their treatment. The team then tallied up every relevant cost, including the price of the drugs themselves, routine medical tests, hospital visits, and the management of side effects, converting all figures into US dollars to allow for clear comparison.

The results of this simulation painted a clear picture. Patients treated with the new ivonescimab combination gained significantly more time with their disease under control and lived longer overall, accumulating nearly three years of quality-adjusted life compared to less than two years for those on the standard treatment. This improvement came with a higher price tag, as the total cost for the new regimen was approximately fifty thousand dollars per patient, compared to roughly twenty-seven thousand dollars for the standard approach. When the researchers divided the extra cost by the extra years of quality life gained, they found that the new treatment cost about twenty-three thousand dollars for each additional year of healthy life. In China, the threshold for what is considered a good value for money in healthcare is set at roughly forty-two thousand dollars per year of healthy life. Because the new treatment's cost per year of life fell well below this limit, the analysis concluded that the extra survival benefit is worth the additional expense.

The study also looked closely at whether this value held true for different types of patients. The researchers tested the model against various groups, including those with low or high levels of a specific protein on their cancer cells and those with cancer that had spread to the liver. In every single group, the new treatment remained a cost-effective choice. The computer simulations were so robust that even when the researchers varied the input numbers to account for uncertainty—such as changing the assumed weight of patients or the exact cost of the drug—the new treatment remained a financially sound option in nearly every scenario. The only factors that made the most difference to the final calculation were the price of the drug itself, the weight of the patient, and how patients felt during the later stages of their illness.

This analysis provides a crucial piece of the puzzle for healthcare decision-makers in China. It suggests that despite the higher upfront price of this novel dual-targeting drug, the substantial gain in survival time and the ability to keep patients alive longer without disease progression makes it a valuable investment for the healthcare system. The findings rely heavily on the fact that the drug's price was negotiated down through national health insurance programs, which brought the cost into a range where the benefits clearly outweigh the expenses. Without this price adjustment, the economic balance might have tipped differently. The study confirms that for patients with advanced squamous non-small cell lung cancer, the new combination therapy offers a meaningful extension of life that the Chinese healthcare system can afford, providing a strong economic argument for its widespread use alongside the clinical evidence of its effectiveness.