{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:19:02Z","timestamp":1791908342271,"version":"4.3.4"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cancer Res Clin Oncol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although pembrolizumab has been shown to be effective, its high price has prevented it from being widely used. Especially in the real world, the application situation is still uncertain. The purpose of this study was to evaluate the cost-effectiveness of pembrolizumab on the basis of real-world studies, from the perspective of the health care system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Retrospectively, 630 patients with advanced NSCLC treated with pembrolizumab (monotherapy or combination chemotherapy) versus chemotherapy alone from January 2020 to December 2022 at a large 3\u00a0A hospital in China were included. Confounders between groups were eliminated using propensity score matching analysis. A partitioned survival model was developed to evaluate the cost-effectiveness of pembrolizumab versus chemotherapy for the treatment of advanced NSCLC based on progression-free survival, overall survival, and the incidence of adverse effects in the two matched groups (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009450 patients). The incremental cost-effectiveness ratio was calculated. The impact of a drug donation program on the cost-effectiveness of pembrolizumab was also evaluated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Pembrolizumab significantly improved median PFS in patients (15.5 months vs. 8.8 months). The median OS in the Pembrolizumab group has not been reached, while it was 26.2 months in the chemotherapy group. When the drug donation program is not considered, the ICER of pembrolizumab is $146,409.07\/QALY. Regardless of whether the willingness-to-pay threshold is set at three times the per capita GDP of China ($36,070.2) or three times the per capita GDP of Guangdong Province ($64,523.8), the use of pembrolizumab is not cost-effective. However, after considering the drug donation program, the ICER decreased to $56,127.74\/QALY. Under the willingness-to-pay threshold of three times the per capita GDP of Guangzhou in 2022 ($64,523.8), pembrolizumab became a cost-effective choice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In the treatment of advanced NSCLC in China, pembrolizumab, particularly when considering the drug donation program, offers better survival outcomes and becomes cost-effective. This highlights the importance of such programs in making high-cost treatments accessible in real-world clinical settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00432-025-06242-6","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T17:11:48Z","timestamp":1761671508000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cost-effectiveness analysis of pembrolizumab versus chemotherapy in advanced non-small cell lung cancer in China based on real-world studies"],"prefix":"10.1007","volume":"151","author":[{"given":"Ning","family":"Wan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ZiJian","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YaJuan","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LiQing","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"WeiBin","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"YongBang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DanDan","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"WenFeng","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ZhuoJia","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"WeiTing","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"6242_CR1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74:229\u2013263. https:\/\/doi.org\/10.3322\/caac.21834","journal-title":"CA Cancer J Clin"},{"key":"6242_CR2","doi-asserted-by":"publisher","first-page":"768035","DOI":"10.3389\/fonc.2021.768035","volume":"11","author":"Y Cai","year":"2021","unstructured":"Cai Y, Hui W, Zhu M, Zhang M, Gao Z, Wu H (2021) Cost-Effectiveness analysis of pembrolizumab plus pemetrexed and platinum versus chemotherapy alone as First-Line treatment in metastatic Non-Squamous Non-Small cell lung cancer: A reconstruction of partitioned survival model based on time dependent pricing mechanism of patient assistance program. Front Oncol 11:768035. https:\/\/doi.org\/10.3389\/fonc.2021.768035","journal-title":"Front Oncol"},{"key":"6242_CR3","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1097\/jcma.0000000000000287","volume":"83","author":"YM Chen","year":"2020","unstructured":"Chen YM (2020) First-line combination immunotherapy for metastatic non-small cell lung cancer. J Chin Med Assoc 83:433\u2013441. https:\/\/doi.org\/10.1097\/jcma.0000000000000287","journal-title":"J Chin Med Assoc"},{"key":"6242_CR4","doi-asserted-by":"publisher","first-page":"e0228288","DOI":"10.1371\/journal.pone.0228288","volume":"15","author":"SD Criss","year":"2020","unstructured":"Criss SD, Palazzo L, Watson TR, Paquette AM, Sigel K, Wisnivesky J, Kong CY (2020) Cost-effectiveness of pembrolizumab for advanced non-small cell lung cancer patients with varying comorbidity burden. PLoS ONE 15:e0228288. https:\/\/doi.org\/10.1371\/journal.pone.0228288","journal-title":"PLoS ONE"},{"key":"6242_CR5","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1200\/jco.2017.77.0412","volume":"36","author":"S Gettinger","year":"2018","unstructured":"Gettinger S, Horn L, Jackman D, Spigel D, Antonia S, Hellmann M, Powderly J, Heist R, Sequist LV, Smith DC, Leming P, Geese WJ, Yoon D, Li A, Brahmer J (2018) Five-Year Follow-Up of nivolumab in previously treated advanced Non-Small-Cell lung cancer: results from the CA209-003 study. J Clin Oncol 36:1675\u20131684. https:\/\/doi.org\/10.1200\/jco.2017.77.0412","journal-title":"J Clin Oncol"},{"key":"6242_CR6","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.lungcan.2018.07.012","volume":"123","author":"X Hu","year":"2018","unstructured":"Hu X, Hay JW (2018) First-line pembrolizumab in PD-L1 positive non-small-cell lung cancer: A cost-effectiveness analysis from the UK health care perspective. Lung Cancer 123:166\u2013171. https:\/\/doi.org\/10.1016\/j.lungcan.2018.07.012","journal-title":"Lung Cancer"},{"key":"6242_CR7","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1136\/ejhpharm-2020-002208","volume":"29","author":"Y Jiang","year":"2022","unstructured":"Jiang Y, Wang X (2022) Cost-effectiveness analysis of pembrolizumab plus standard chemotherapy versus chemotherapy alone for first-line treatment of metastatic non-squamous non-small-cell lung cancer in China. Eur J Hosp Pharm 29:139\u2013144. https:\/\/doi.org\/10.1136\/ejhpharm-2020-002208","journal-title":"Eur J Hosp Pharm"},{"key":"6242_CR8","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1080\/13696998.2019.1570221","volume":"22","author":"W Liao","year":"2019","unstructured":"Liao W, Huang J, Hutton D, Li Q (2019) Cost-effectiveness analysis of first-line pembrolizumab treatment for PD-L1 positive, non-small cell lung cancer in China. J Med Econ 22:344\u2013349. https:\/\/doi.org\/10.1080\/13696998.2019.1570221","journal-title":"J Med Econ"},{"key":"6242_CR9","doi-asserted-by":"publisher","first-page":"e195","DOI":"10.1111\/ajco.12477","volume":"13","author":"B Nafees","year":"2017","unstructured":"Nafees B, Lloyd AJ, Dewilde S, Rajan N, Lorenzo M (2017) Health state utilities in non-small cell lung cancer: an international study. Asia Pac J Clin Oncol 13:e195\u2013e203. https:\/\/doi.org\/10.1111\/ajco.12477","journal-title":"Asia Pac J Clin Oncol"},{"key":"6242_CR10","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1111\/1759-7714.14148","volume":"12","author":"TR Peng","year":"2021","unstructured":"Peng TR, Lin HH, Tsai FP, Wu TW (2021) Immune checkpoint inhibitors for first-line treatment of advanced non-small-cell lung cancer: A systematic review and network meta-analysis. Thorac Cancer 12:2873\u20132885. https:\/\/doi.org\/10.1111\/1759-7714.14148","journal-title":"Thorac Cancer"},{"key":"6242_CR11","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/j.annonc.2020.02.006","volume":"31","author":"D Planchard","year":"2020","unstructured":"Planchard D, Reinmuth N, Orlov S, Fischer JR, Sugawara S, Mandziuk S, Marquez-Medina D, Novello S, Takeda Y, Soo R, Park K, McCleod M, Geater SL, Powell M, May R, Scheuring U, Stockman P, Kowalski D (2020) ARCTIC: durvalumab with or without Tremelimumab as third-line or later treatment of metastatic non-small-cell lung cancer. Ann Oncol 31:609\u2013618. https:\/\/doi.org\/10.1016\/j.annonc.2020.02.006","journal-title":"Ann Oncol"},{"key":"6242_CR12","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1586\/14737140.2016.1170596","volume":"16","author":"A Rossi","year":"2016","unstructured":"Rossi A, Di Maio M (2016) Platinum-based chemotherapy in advanced non-small-cell lung cancer: optimal number of treatment cycles. Expert Rev Anticancer Ther 16:653\u2013660. https:\/\/doi.org\/10.1586\/14737140.2016.1170596","journal-title":"Expert Rev Anticancer Ther"},{"key":"6242_CR13","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1111\/1759-7714.13272","volume":"11","author":"A Ruiz-Pati\u00f1o","year":"2020","unstructured":"Ruiz-Pati\u00f1o A, Arrieta O, Cardona AF, Mart\u00edn C, Raez LE, Zatarain-Barr\u00f3n ZL, Barr\u00f3n F, Ricaurte L, Bravo-Garz\u00f3n MA, Mas L, Corrales L, Rojas L, Lupinacci L, Perazzo F, Bas C, Carranza O, Puparelli C, Rizzo M, Ruiz R, Rolfo C, Archila P, Rodr\u00edguez J, Sotelo C, Vargas C, Carranza H, Otero J, Pino LE, Ort\u00edz C, Laguado P, Rosell R (2020) Immunotherapy at any line of treatment improves survival in patients with advanced metastatic non-small cell lung cancer (NSCLC) compared with chemotherapy (Quijote-CLICaP). Thorac Cancer 11:353\u2013361. https:\/\/doi.org\/10.1111\/1759-7714.13272","journal-title":"Thorac Cancer"},{"key":"6242_CR14","doi-asserted-by":"publisher","first-page":"174404","DOI":"10.1016\/j.ejphar.2021.174404","volume":"909","author":"MJ Sanaei","year":"2021","unstructured":"Sanaei MJ, Pourbagheri-Sigaroodi A, Kaveh V, Abolghasemi H, Ghaffari SH, Momeny M, Bashash D (2021) Recent advances in immune checkpoint therapy in non-small cell lung cancer and opportunities for nanoparticle-based therapy. Eur J Pharmacol 909:174404. https:\/\/doi.org\/10.1016\/j.ejphar.2021.174404","journal-title":"Eur J Pharmacol"},{"key":"6242_CR15","doi-asserted-by":"publisher","first-page":"e454","DOI":"10.1002\/onco.13590","volume":"26","author":"EL Schenk","year":"2021","unstructured":"Schenk EL, Patil T, Pacheco J, Bunn PA Jr. (2021) 2020 Innovation-Based optimism for lung Cancer outcomes. Oncologist 26:e454\u2013e472. https:\/\/doi.org\/10.1002\/onco.13590","journal-title":"Oncologist"},{"key":"6242_CR16","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1016\/j.ejca.2016.03.081","volume":"62","author":"LH Schwartz","year":"2016","unstructured":"Schwartz LH, Liti\u00e8re S, de Vries E, Ford R, Gwyther S, Mandrekar S, Shankar L, Bogaerts J, Chen A, Dancey J, Hayes W, Hodi FS, Hoekstra OS, Huang EP, Lin N, Liu Y, Therasse P, Wolchok JD, Seymour L (2016) RECIST 1.1-Update and clarification: from the RECIST committee. Eur J Cancer 62:132\u2013137. https:\/\/doi.org\/10.1016\/j.ejca.2016.03.081","journal-title":"Eur J Cancer"},{"key":"6242_CR17","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.21037\/atm-21-4178","volume":"9","author":"Y Shi","year":"2021","unstructured":"Shi Y, Chen W, Zhang Y, Bo M, Li C, Zhang M, Li G (2021) Cost-effectiveness of pembrolizumab versus docetaxel as second-line treatment of non-small cell lung cancer in China. Ann Transl Med 9:1480. https:\/\/doi.org\/10.21037\/atm-21-4178","journal-title":"Ann Transl Med"},{"key":"6242_CR18","doi-asserted-by":"publisher","first-page":"4955","DOI":"10.2147\/ott.S200615","volume":"12","author":"N Wan","year":"2019","unstructured":"Wan N, Ji B, Li J, Jiang J, Yang C, Zhang T, Huang W (2019) A pooled meta-analysis of PD-1\/L1 inhibitors incorporation therapy for advanced non-small cell lung cancer. Onco Targets Ther 12:4955\u20134973. https:\/\/doi.org\/10.2147\/ott.S200615","journal-title":"Onco Targets Ther"},{"key":"6242_CR19","doi-asserted-by":"publisher","first-page":"1683","DOI":"10.1002\/cam4.2793","volume":"9","author":"N Wan","year":"2020","unstructured":"Wan N, Zhang TT, Hua SH, Lu ZL, Ji B, Li LX, Lu LQ, Huang WJ, Jiang J, Li J (2020) Cost-effectiveness analysis of pembrolizumab plus chemotherapy with PD-L1 test for the first-line treatment of NSCLC. Cancer Med 9:1683\u20131693. https:\/\/doi.org\/10.1002\/cam4.2793","journal-title":"Cancer Med"},{"key":"6242_CR20","doi-asserted-by":"publisher","first-page":"e031019","DOI":"10.1136\/bmjopen-2019-031019","volume":"9","author":"X Zeng","year":"2019","unstructured":"Zeng X, Wan X, Peng L, Peng Y, Ma F, Liu Q, Tan C (2019) Cost-effectiveness analysis of pembrolizumab plus chemotherapy for previously untreated metastatic non-small cell lung cancer in the USA. BMJ Open 9:e031019. https:\/\/doi.org\/10.1136\/bmjopen-2019-031019","journal-title":"BMJ Open"},{"key":"6242_CR21","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.lungcan.2019.08.028","volume":"136","author":"K Zhou","year":"2019","unstructured":"Zhou K, Jiang C, Li Q (2019) Cost-effectiveness analysis of pembrolizumab monotherapy and chemotherapy in the non-small-cell lung cancer with different PD-L1 tumor proportion scores. Lung Cancer 136:98\u2013101. https:\/\/doi.org\/10.1016\/j.lungcan.2019.08.028","journal-title":"Lung Cancer"},{"key":"6242_CR22","doi-asserted-by":"publisher","first-page":"735536","DOI":"10.3389\/fphar.2021.735536","volume":"12","author":"C Zhu","year":"2021","unstructured":"Zhu C, Xing XX, Wu B, Liang G, Han G, Lin CX, Fang HM (2021) Cost-Effectiveness analysis of camrelizumab plus chemotherapy vs. chemotherapy alone as the First-Line treatment in patients with IIIB-IV Non-Squamous Non-Small cell lung Cancer (NSCLC) without EGFR and ALK alteration from a perspective of Health - Care system in China. Front Pharmacol 12:735536. https:\/\/doi.org\/10.3389\/fphar.2021.735536","journal-title":"Front Pharmacol"}],"container-title":["Journal of Cancer Research and Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00432-025-06242-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00432-025-06242-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00432-025-06242-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T19:39:07Z","timestamp":1765654747000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00432-025-06242-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,28]]},"references-count":22,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6242"],"URL":"https:\/\/doi.org\/10.1007\/s00432-025-06242-6","relation":{},"ISSN":["1432-1335"],"issn-type":[{"value":"1432-1335","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,28]]},"assertion":[{"value":"9 May 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study received ethical approval from the Ethics Committee of Sun Yat-sen University Cancer Center in 2022 (Sun Yat-sen University Cancer Center Ethics Committee No. B2022-153-01.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"306"}}