Cost-effectiveness analysis of immune checkpoint inhibitors versus platinum-based doublet chemotherapy in the first-line treatment of advanced non-small-cell lung cancer with High PD-L1 expression in Japan

Chanon Nusawat; So Sato; Jumpei Taniguchi; Yuya Kimura; Hideo Yasunaga

doi:10.1007/s10198-026-01912-9

Cost-effectiveness analysis of immune checkpoint inhibitors versus platinum-based doublet chemotherapy in the first-line treatment of advanced non-small-cell lung cancer with High PD-L1 expression in Japan

Eur J Health Econ. 2026 Mar 4. doi: 10.1007/s10198-026-01912-9. Online ahead of print.

Authors

Chanon Nusawat¹, So Sato², Jumpei Taniguchi², Yuya Kimura³, Hideo Yasunaga²

Affiliations

¹ Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan. chanon-n@g.ecc.u-tokyo.ac.jp.
² Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan.
³ Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

PMID: 41779321
DOI: 10.1007/s10198-026-01912-9

Abstract

Background: This study comprehensively evaluated the cost-effectiveness of pembrolizumab, atezolizumab, and nivolumab plus ipilimumab compared with platinum-based doublet chemotherapy as the first-line treatment for advanced NSCLC with PD-L1 TPS ≥ 50% in Japan, incorporating recent Japan-specific clinical trial data and real-world cost estimates from a nationwide administrative database.

Methods: A Markov model was developed to conduct the cost-effectiveness comparison. The model simulated patient transitions between progression-free status, progressed disease, and death over a lifetime horizon using a six-week cycle. Clinical effectiveness data were obtained from pivotal trials, with transition probabilities adjusted using Japanese-specific survival data. Health state utilities were derived from published literature using the EQ-5D questionnaire. Costs were derived from the Diagnosis Procedure Combination database. The analysis was conducted from the Japanese health care payer's perspective, using quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs). One-way deterministic and probabilistic sensitivity analyses were performed.

Results: Pembrolizumab had the most favorable cost-effectiveness profile, with an ICER of USD 13,423/QALY, well within Japan's willingness-to-pay threshold of USD 35,000/QALY. Nivolumab plus ipilimumab had an ICER of USD 31,150/QALY, whereas atezolizumab had the highest ICER at USD 44,281/QALY. Sensitivity analyses identified key ICER drivers. Results from probabilistic sensitivity analyses were consistent with those of the primary analyses.

Conclusions: Pembrolizumab is a cost-effective first-line treatment for advanced NSCLC with PD-L1 TPS ≥ 50% in Japan. Nivolumab plus ipilimumab is also a viable option. Atezolizumab is the least cost-effective.

Keywords: Advanced non-small-cell lung cancer; Atezolizumab; Cost-effectiveness analysis; Ipilimumab; Nivolumab; Pembrolizumab.