{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T18:47:40Z","timestamp":1765738060248,"version":"3.48.0"},"reference-count":30,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T00:00:00Z","timestamp":1659571200000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,7,13]]},"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      Camrelizumab is a selective, humanised, high-affinity IgG\n                      <jats:sub>4<\/jats:sub>\n                      kappa monoclonal antibody against programmed cell death 1 that shows effective antitumour activity with acceptable toxicity in multiple tumour types. The CameL trial demonstrated that camrelizumab plus chemotherapy (CC) significantly prolonged the median progression-free survival and median overall survival versus chemotherapy alone (CA) in patients with advanced non-squamous non-small cell lung cancer (NSCLC). Our study was conducted to investigate the cost-effectiveness of the two strategies in chemotherapy-naive patients with advanced non-squamous NSCLC.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting and participants<\/jats:title>\n                    <jats:p>A Markov simulation model was generated based on the CameL trial. The two simulated treatments included CC and CA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Utility was derived from published literature, and costs were calculated based on those at our hospital in Chengdu, China. Incremental cost-effectiveness ratios (ICERs) were calculated to compare the cost-effectiveness of the two treatment arms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the overall population, the total costs were $27\u2009223.40 and $13\u2009740.10 for CC and CA treatment, respectively. The CC treatment produced 1.37 quality-adjusted life years (QALYs), and the CA treatment produced 1.17 QALYs. Hence, patients who were in the CC group spent an additional $13\u2009483.30 and generated an increase of 0.20 QALYs, resulting in an ICER of $67\u2009416.50 per QALY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>For chemotherapy-naive patients with advanced non-squamous NSCLC, CC is not considered a cost-effective treatment versus CA in China when considering a willingness-to-pay threshold of $31\u2009500 per QALY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03134872\">NCT03134872<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-061592","type":"journal-article","created":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T11:29:42Z","timestamp":1661426982000},"page":"e061592","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Camrelizumab in patients with advanced non-squamous non-small cell lung cancer: a cost-effective analysis in China"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct03134872","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Qian","family":"Xie","sequence":"first","affiliation":[{"name":"General Practice Ward\/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hanrui","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Na","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0380-113X","authenticated-orcid":false,"given":"Qiu","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,8,5]]},"reference":[{"key":"2025121410425483000_12.8.e061592.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"2025121410425483000_12.8.e061592.2","doi-asserted-by":"crossref","DOI":"10.1186\/s40880-019-0368-6","article-title":"Current cancer situation in China: good or bad news from the 2018 global cancer statistics?","volume":"39","author":"Feng","year":"2019","journal-title":"Cancer Commun"},{"key":"2025121410425483000_12.8.e061592.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1709937"},{"key":"2025121410425483000_12.8.e061592.4","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.26.2543"},{"key":"2025121410425483000_12.8.e061592.5","doi-asserted-by":"crossref","first-page":"ii50","DOI":"10.1093\/annonc\/mdx091.064","article-title":"CheckMate 227: a randomized, open-label phase 3 trial of nivolumab, nivolumab plus ipilimumab, or nivolumab plus chemotherapy versus chemotherapy in chemotherapy-na\u00efve patients with advanced non-small cell lung cancer (NSCLC)","volume":"28","author":"Paz-Ares","year":"2017","journal-title":"Annals of Oncology"},{"key":"2025121410425483000_12.8.e061592.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1606774"},{"key":"2025121410425483000_12.8.e061592.7","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1910231"},{"key":"2025121410425483000_12.8.e061592.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32409-7"},{"key":"2025121410425483000_12.8.e061592.9","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-19-1680"},{"key":"2025121410425483000_12.8.e061592.10","doi-asserted-by":"crossref","first-page":"S382","DOI":"10.1016\/j.jtho.2019.08.776","article-title":"P1.01-61 a phase II umbrella study of Camrelizumab in different PD-L1 expression cohorts in pre-treated advanced\/metastatic non-small cell lung cancer","volume":"14","author":"Wu","year":"2019","journal-title":"J Thorac Oncol"},{"key":"2025121410425483000_12.8.e061592.11","doi-asserted-by":"crossref","first-page":"305-314","DOI":"10.1016\/S2213-2600(20)30365-9","article-title":"Camrelizumab plus carboplatin and pemetrexed versus chemotherapy alone in chemotherapy-naive patients with advanced non-squamous non-small-cell lung cancer (camel): a randomised, open-label, multicentre, phase 3 trial","volume":"9","author":"Zhou","year":"2021","journal-title":"Lancet Respir Med"},{"key":"2025121410425483000_12.8.e061592.12","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-11-139"},{"key":"2025121410425483000_12.8.e061592.13","doi-asserted-by":"crossref","first-page":"2354","DOI":"10.1200\/JCO.2000.18.12.2354","article-title":"Randomized phase III trial of docetaxel versus vinorelbine or ifosfamide in patients with advanced non-small-cell lung cancer previously treated with platinum-containing chemotherapy regimens. The Tax 320 non-small cell lung cancer Study Group","volume":"18","author":"Fossella","year":"2000","journal-title":"J Clin Oncol"},{"key":"2025121410425483000_12.8.e061592.14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0032530"},{"key":"2025121410425483000_12.8.e061592.15","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e318299243b"},{"key":"2025121410425483000_12.8.e061592.16","doi-asserted-by":"crossref","first-page":"443","DOI":"10.2217\/cer-2017-0069","article-title":"Health state utilities in patients with advanced non-small-cell lung cancer in China","volume":"7","author":"Shen","year":"2018","journal-title":"J Comp Eff Res"},{"key":"2025121410425483000_12.8.e061592.17","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1002\/cac2.12119","article-title":"Phase II clinical trial using camrelizumab combined with apatinib and chemotherapy as the first-line treatment of advanced esophageal squamous cell carcinoma","volume":"40","author":"Zhang","year":"2020","journal-title":"Cancer Commun"},{"key":"2025121410425483000_12.8.e061592.18","doi-asserted-by":"crossref","first-page":"153303382097970","DOI":"10.1177\/1533033820979703","article-title":"Experience with anti-PD-1 antibody, Camrelizumab, monotherapy for biliary tract cancer patients and literature review","volume":"19","author":"Shen","year":"2020","journal-title":"Technol Cancer Res Treat"},{"key":"2025121410425483000_12.8.e061592.19","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(20)30110-8"},{"key":"2025121410425483000_12.8.e061592.20","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.jtho.2020.10.002","article-title":"Camrelizumab plus apatinib in extensive-stage SCLC (passion): a multicenter, two-stage, phase 2 trial","volume":"16","author":"Fan","year":"2021","journal-title":"J Thorac Oncol"},{"key":"2025121410425483000_12.8.e061592.21","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1080\/17474124.2020.1807939","article-title":"The clinical application of camrelizumab on advanced hepatocellular carcinoma","volume":"14","author":"Chen","year":"2020","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"2025121410425483000_12.8.e061592.22","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1007\/s40273-017-0527-z","article-title":"Cost effectiveness of pembrolizumab vs. standard-of-care chemotherapy as first-line treatment for metastatic NSCLC that expresses high levels of PD-L1 in the United States","volume":"35","author":"Huang","year":"2017","journal-title":"Pharmacoeconomics"},{"key":"2025121410425483000_12.8.e061592.23","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.ctrv.2016.06.002","article-title":"Economic sustainability of anti-PD-1 agents nivolumab and pembrolizumab in cancer patients: recent insights and future challenges","volume":"48","author":"Tartari","year":"2016","journal-title":"Cancer Treat Rev"},{"key":"2025121410425483000_12.8.e061592.24","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.lungcan.2018.08.018","article-title":"Cost-Effectiveness of pembrolizumab as first-line therapy for advanced non-small cell lung cancer","volume":"124","author":"Georgieva","year":"2018","journal-title":"Lung Cancer"},{"key":"2025121410425483000_12.8.e061592.25","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.lungcan.2018.11.008","article-title":"Cost-effectiveness analysis of pembrolizumab versus standard-of-care chemotherapy for first-line treatment of PD-L1 positive (>50%) metastatic squamous and non-squamous non-small cell lung cancer in France","volume":"127","author":"Chouaid","year":"2019","journal-title":"Lung Cancer"},{"key":"2025121410425483000_12.8.e061592.26","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1080\/13696998.2019.1570221","article-title":"Cost-Effectiveness analysis of first-line pembrolizumab treatment for PD-L1 positive, non-small cell lung cancer in China","volume":"22","author":"Liao","year":"2019","journal-title":"J Med Econ"},{"key":"2025121410425483000_12.8.e061592.27","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.lungcan.2019.08.028","article-title":"Cost-Effectiveness analysis of pembrolizumab monotherapy and chemotherapy in the non-small-cell lung cancer with different PD-L1 tumor proportion scores","volume":"136","author":"Zhou","year":"2019","journal-title":"Lung Cancer"},{"key":"2025121410425483000_12.8.e061592.28","doi-asserted-by":"crossref","first-page":"3526","DOI":"10.1002\/cncr.32368","article-title":"First-Line atezolizumab in addition to bevacizumab plus chemotherapy for metastatic, nonsquamous non-small cell lung cancer: a United States-based cost-effectiveness analysis","volume":"125","author":"Wan","year":"2019","journal-title":"Cancer"},{"key":"2025121410425483000_12.8.e061592.29","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2020.01649","article-title":"Cost-Effectiveness analysis of nivolumab plus ipilimumab vs. chemotherapy as first-line therapy in advanced non-small cell lung cancer","volume":"10","author":"Hu","year":"2020","journal-title":"Front Oncol"},{"key":"2025121410425483000_12.8.e061592.30","doi-asserted-by":"publisher","DOI":"10.7326\/M20-1392"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-061592","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T18:43:11Z","timestamp":1765737791000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-061592"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8]]},"references-count":30,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8,5]]},"published-print":{"date-parts":[[2022,8]]}},"alternative-id":["10.1136\/bmjopen-2022-061592"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-061592","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2022,8]]}}}