Objective  To evaluate the cost-effectiveness of the sacituzumab tirumotecan (sac-TMT) versus platinum-based chemotherapy as second-line treatment for progressed EGFR-mutant non-small cell lung cancer (NSCLC) from the perspective of China's healthcare system.

Methods  A Markov model was constructed based on the OptiTROP-Lung04 trial. The model was set with a 28-day cycle and a 10-year simulation horizon. The primary outcomes included total cost, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) . The robustness of the results was verified through one-way sensitivity analysis and probabilistic sensitivity analysis (PSA), along with corresponding scenario analyses.

Results  Compared with the chemotherapy group, the sac-TMT group was associated with an incremental cost of 194,521.32 yuan and an incremental effectiveness of 0.68 QALYs, yielding an ICER of 286,907.68 yuan·QALY^-¹, which was considerably higher than the willingness-to-pay (WTP) threshold of two times the 2024 per capita gross domestic product (GDP). One-way sensitivity analysis demonstrated that the utility values of progression-free survival and disease progression had relatively substantial impacts on the ICER, but did not alter the primary findings of the base-case analysis. PSA indicated that the sac-TMT group had a 0% probability of being cost-effective under the predefined WTP threshold in this study. Scenario analysis revealed that the cost-effective probability of this regimen increased to 100% when the indication was covered by medical insurance or the WTP threshold was elevated.

Conclusion  The sac-TMT regimen is unlikely to be cost-effective compared with platinum-based chemotherapy for EGFR-mutant NSCLC under the current economic conditions in China.

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