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Life sciences · Journal article
BMC Health Services Research · October 24, 2026
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The cost-effectiveness of ivonescimab plus chemotherapy as a potential new standard of care for advanced squamous non-small cell lung cancer (NSCLC) remains unestablished. While the introduction of innovative dual-targeted agents like ivonescimab holds promise for enhancing patient outcomes in China, their substantial financial burden raises critical questions regarding economic viability and value. This study aimed to evaluate the economic value of first-line ivonescimab plus chemotherapy versus tislelizumab plus chemotherapy for this patient population from the perspective of the Chinese healthcare system. Clinical data were extracted from the published randomized controlled trial, HARMONi-6. A decision-analytic Markov model was constructed to project the long-term economic and health outcomes associated with ivonescimab plus chemotherapy versus tislelizumab plus chemotherapy over a 10-year time horizon. The primary outcomes evaluated were life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). To test the robustness of the model and address parameter uncertainty, univariate sensitivity analyses, probabilistic sensitivity analyses (PSA), and scenario analyses were performed. Compared with the tislelizumab combination, the ivonescimab plus chemotherapy regimen yielded an incremental 0.1947 QALYs, resulting in an ICER of $279,130.2396 per QALY. At a willingness-to-pay (WTP) threshold of $43,969.85/QALY, the ivonescimab-based therapy was not economically viable. Univariate sensitivity analyses revealed that the model was highly sensitive to the cost of ivonescimab, the utility of progression-free disease, and the disutility of adverse events in the ivonescimab arm. PSA confirmed that the probability of ivonescimab plus chemotherapy being cost-effective at the designated threshold was 0%. However, price simulation analysis indicated that reducing the price of ivonescimab by 68% to $108.23 per vial achieved a 0.20% probability of cost-effectiveness; a price reduction of 84.5% ($52.40 per vial) rendered the regimen 99% cost-effective under the same threshold. From the perspective of the Chinese healthcare system, first-line ivonescimab plus chemotherapy for advanced squamous NSCLC is not a cost-effective alternative at its current market price. Nevertheless, with the support of national medical insurance policies and the implementation of drug price reduction strategies, this innovative bispecific antibody therapy is expected to achieve affordability and economic value within China’s healthcare system. Not applicable.