Cost-Effectiveness of Ivonescimab Plus Chemotherapy Versus Chemotherapy Alone in EGFR-Mutant Non-Small Cell Lung Cancer After EGFR-TKI Failure: A Partitioned Survival Analysis of the HARMONi-A Randomized Clinical Trial
Abstract
Abstract Background In the HARMONi-A phase 3 trial, ivonescimab—a first-in-class PD-1/VEGF bispecific antibody—added to platinum-pemetrexed chemotherapy significantly improved progression-free survival compared with chemotherapy alone in patients with EGFR-mutant non-small cell lung cancer (NSCLC) whose disease had progressed on EGFR tyrosine kinase inhibitor therapy (hazard ratio 0.46; median 7.1 vs 4.8 months). Whether this efficacy gain represents high-value care from the Chinese healthcare system perspective is unknown. Methods We constructed a three-state partitioned survival model with a 21-day cycle length and a 10-year time horizon. Weibull parametric survival functions were fitted to published HARMONi-A landmark survival data and calibrated to reproduce the trial’s reported median progression-free and overall survival to within 0.1 months. Drug costs reflected 2025 China National Reimbursement Drug List negotiated prices, including ivonescimab at $1,227 per 21-day cycle (¥736 per 100 mg vial). The willingness-to-pay threshold was set at $41,527 per quality-adjusted life-year (QALY)—three times China’s 2025 gross domestic product per capita. We conducted one-way and probabilistic sensitivity analyses (1,000 Monte Carlo iterations). Results Ivonescimab plus chemotherapy produced 0.884 QALYs at a cost of $48,266, versus 0.724 QALYs at $29,094 for chemotherapy alone, yielding an incremental cost-effectiveness ratio (ICER) of $119,512 per QALY—188% above the…
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