Cost-Effectiveness Analysis of Ivonescimab Plus Chemotherapy versus Tislelizumab Plus Chemotherapy as First-Line Treatment for Advanced Squamous Non-Small-Cell Lung Cancer in China Based on the HARMONi-6 Trial.

BACKGROUND: Ivonescimab plus chemotherapy improved survival compared with tislelizumab plus chemotherapy in the HARMONi-6 trial for first-line advanced squamous non-small-cell lung cancer (sq-NSCLC). However, its economic value in China remains unclear. METHODS: From the perspective of the Chinese healthcare system, a partitioned survival model was developed to assess the cost-effectiveness of ivonescimab plus chemotherapy versus tislelizumab plus chemotherapy using efficacy and safety data from HARMONi-6. Analyses were conducted in the overall randomly assigned population and programmed death-ligand 1 tumor proportion score (PD-L1 TPS) subgroups. Outcomes included costs, life-years (LYs), quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), incremental net monetary benefits (INMBs), incremental net health benefits (INHBs), and cost-effectiveness probabilities. The willingness-to-pay (WTP) threshold was $27,906 per QALY. Sensitivity, scenario, subgroup, and price simulation analyses were performed. RESULTS: In the overall population, ivonescimab plus chemotherapy increased costs compared with tislelizumab plus chemotherapy ($77,730.17 vs $40,088.29) and improved outcomes, with 3.5912 versus 2.3113 LYs and 2.9059 versus 1.8704 QALYs. The incremental cost was $37,641.88, with gains of 1.2799 LYs and 1.0355 QALYs, resulting in an ICER of $36,351.02 per QALY. Across PD-L1 TPS subgroups, all ICERs exceeded the WTP threshold. Probabilistic sensitivity analysis showed a 9.7% probability of cost-effectiveness at $27,906 per QALY, increasing to 87.5% at $41,859 per QALY. Price simulation indicated that ivonescimab would need to be priced at no more than $69.59 per 100 mg to be cost-effective at $27,906 per QALY. CONCLUSION: Ivonescimab plus chemotherapy provided greater survival benefits than tislelizumab plus chemotherapy but was unlikely to be cost-effective relative to tislelizumab plus chemotherapy in China at the current price.