Cost-effectiveness analysis of sacituzumab tirumotecan vs. chemotherapy for patients with EGFR-TKI-resistant, EGFR-mutated advanced non-small cell lung cancer in China.

BACKGROUND: In the OptiTROP-Lung04 trial, sacituzumab tirumotecan (sac-TMT) yielded a median progression-free survival of 8.3 months-a clinically significant outcome that has approval by the National Medical Products Administration. This study evaluates the cost-effectiveness of sac-TMT as a later-line therapy for patients with EGFR-mutant advanced NSCLC who have progressed on EGFR-TKIs, from the perspective of Chinese healthcare system. METHODS: A partitioned survival model was constructed to simulate patients' health state transitions in 28-day cycles and predict long-term survival and economic outcomes over a 10-year time horizon for the two treatment strategies. Clinical data were sourced from the OptiTROP-Lung04 trial, whereas cost and utility parameters were extracted from local medical charges and published literatures. The model calculated total costs, life-years (LYs), quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were conducted to verify the robustness of model outputs. Scenario analyses evaluated changes in the ICER under different sac-TMT price levels and alternative time horizons. Subgroup analyses estimated ICER values corresponding to hazard ratios across distinct subgroups. RESULTS: Compared with the chemotherapy group, sac-TMT incurred an incremental cost of $28,285.28 and generated an additional 0.84 QALYs and 1.74 LYs, yielding an ICER of $33,514.79/QALY. One-way sensitivity analysis revealed that cost of sac-TMT, progression-free survival (PFS) utility value, and discount rate were the three parameters exerting the strongest influence on the ICER. Probabilistic sensitivity analysis indicated that sac-TMT had a 23.90% probability of being cost-effective. Scenario analysis demonstrated that the ICER would precisely hit the cost-effectiveness threshold ($27,906.03/QALY) if the unit price of sac-TMT decreased to $541.55/200 mg. CONCLUSIONS: Based on this analytical model, sac-TMT is unlikely to be cost-effective for Chinese patients with EGFR-TKI-resistant, EGFR-mutated advanced NSCLC. Nevertheless, a further price reduction of 14.98% would make it cost-effective.