First-line treatments for metastatic non-small-cell lung cancer with Sugemalimab plus chemotherapy: a China-based cost-effectiveness analysis

Objective To assess the cost-effectiveness of sugemalimab plus chemotherapy as first-line treatment for metastatic Non-small cell lung cancer(NSCLC) in China. Methods A three-state Markov model with 21-day cycles over 10 years was developed to compare sugemalimab plus chemotherapy versus placebo plus chemotherapy. Key model inputs were derived from the 4-year survival data of the GEMSTONE-302 trial and publicly available sources. Outcomes were measured in quality-adjusted life years(QALYs) and incremental cost-effectiveness ratios(ICERs). The willingness-to-pay(WTP) threshold was set at three times the per capita GDP of China in 2024(40,062.34$/QALY). Sensitivity analyses were performed to assess model robustness. Results Base-case ICERs were 65,766.82$/QALY for squamous and 70,117.72$/QALY for non-squamous NSCLC, both above the WTP threshold. Subgroup analyses indicated that patients with PD-L1 expression ≥ 50% had the most favorable ICER(60,516.14$/QALY), while those with PD-L1 < 1% had the least favorable outcome(80,599.12$/QALY). Sensitivity analyses identified drug price and utility values as the most influential parameters affecting ICERs. Conclusion Sugemalimab plus platinum-based chemotherapy offers long-term clinical benefits for metastatic NSCLC but is not cost-effective at current prices in China. Improving cost-effectiveness may require targeting patients with high PD-L1 expression, adjusting reimbursement policies, and reducing drug prices.