{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:02:09Z","timestamp":1791219729913,"version":"4.1.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim of this study was to evaluate the cost-effectiveness of toripalimab plus chemotherapy compared to chemotherapy alone as first-line therapy for extensive-stage small cell lung cancer(ES-SCLC) from the Chinese medical perspective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Our study utilized a partitioned survival model to estimate the costs and clinical outcomes for patients with ES-SCLC. The model incorporated direct healthcare costs and clinical outcomes.The primary outcome measures used in our analysis were quality adjusted life year (QALY) and incremental cost-effectiveness ratio (ICER). These measures were employed to evaluate the cost-effectiveness advantage of the treatment strategy by comparing it to the willingness-to-pay (WTP) thresholds. To account for uncertainties in the model results, One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty of the model results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The base-case analysis showed that the total cost for toripalimab plus chemotherapy was $50,918.81, while the cost for chemotherapy was $20,280.31.The combination toripalimab therapy led to a higher QALY value of\u00a01.59 compared to 0.55 for chemotherapy. This translated into an ICER of $29,460.09 per QALY gained, which was below the WTP threshold of $40,343.68 per QALY. The results of the sensitivity analyses demonstrated that the findings were not significantly affected by changes in any of the input parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our analysis suggests that toripalimab plus chemotherapy is likely to be a cost-effective first-line therapy for ES-SCLC compared to chemotherapy alone, based on the WTP threshold of $40343.68 per QALY.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1591517","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T05:29:09Z","timestamp":1751347749000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Toripalimab plus chemotherapy versus chemotherapy as first-line therapy for extensive-stage small cell lung cancer: a cost-effectiveness analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Longfeng","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongcai","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huide","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwei","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"10","DOI":"10.3322\/caac.21871","article-title":"Cancer statistics, 2025","volume":"75","author":"Siegel","year":"2025","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctrv.2024.102798","article-title":"Challenges and future perspectives for the use of temozolomide in the treatment of SCLC","volume":"129","author":"Andrini","year":"2024","journal-title":"Cancer Treat Rev"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2025.104618","article-title":"Real-world evidence in extensive disease small cell lung cancer: The missing piece of the puzzle","volume":"207","author":"Damiano","year":"2025","journal-title":"Crit Rev Oncol Hematol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21785","article-title":"Clinical insights into small cell lung cancer: Tumor heterogeneity, diagnosis, therapy, and future directions","volume":"73","author":"Megyesfalvi","year":"2023","journal-title":"CA Cancer J Clin"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2021.0058","article-title":"Small cell lung cancer, version 2.2022, NCCN clinical practice guidelines in oncology","volume":"19","author":"Ganti","year":"2021","journal-title":"J Natl Compr Canc Netw"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2020.01074","article-title":"Update on the biology, management, and treatment of small cell lung cancer (SCLC)","volume":"10","author":"Saltos","year":"2020","journal-title":"Front Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1177\/17588359231189430","article-title":"Efficacy and safety of first-line PD-1\/PD-L1 inhibitor combinations for extensive-stage small-cell lung cancer: a Bayesian network meta-analysis","volume":"15","author":"Li","year":"2023","journal-title":"Ther Adv Med Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.1059557","article-title":"Combining PD-1 or PD-L1 inhibitors with chemotherapy is a good strategy for the treatment of extensive small cell lung cancer: A retrospective analysis of clinical studies","volume":"13","author":"Luo","year":"2022","journal-title":"Front Immunol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.00793","article-title":"Pembrolizumab or placebo plus etoposide and platinum as first-line therapy for extensive-stage small-cell lung cancer: randomized, double-blind, phase III KEYNOTE-604 study","volume":"38","author":"Rudin","year":"2020","journal-title":"J Clin Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.01055","article-title":"Updated overall survival and PD-L1 subgroup analysis of patients with extensive-stage small-cell lung cancer treated with atezolizumab, carboplatin, and etoposide (IMpower133)","volume":"39","author":"Liu","year":"2021","journal-title":"J Clin Oncol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1001\/jamaoncol.2024.5019","article-title":"Toripalimab plus chemotherapy as a first-line therapy for extensive-stage small cell lung cancer: the phase 3 EXTENTORCH randomized clinical trial","volume":"11","author":"Cheng","year":"2025","journal-title":"JAMA Oncol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e35614","DOI":"10.1097\/MD.0000000000035614","article-title":"A review of cost-effectiveness analysis: From theory to clinical practice","volume":"102","author":"Michelly Gon\u00e7alves Brand\u00e3o","year":"2023","journal-title":"Med (Baltimore)"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1362","article-title":"Estimating hazard ratios from published Kaplan-Meier survival curves: A methods validation study","volume":"10","author":"Saluja","year":"2019","journal-title":"Res Synth Methods"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1177\/0272989X16670617","article-title":"Estimation of survival probabilities for use in cost-effectiveness analyses: A comparison of a multi-state modeling survival analysis approach with partitioned survival and markov decision-analytic modeling","volume":"37","author":"Williams","year":"2017","journal-title":"Med Decis Making"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-013-0123-9","article-title":"Survival modeling for the estimation of transition probabilities in model-based economic evaluations in the absence of individual patient data: a tutorial","volume":"32","author":"Diaby","year":"2014","journal-title":"Pharmacoeconomics"},{"key":"B16","unstructured":"2024"},{"key":"B17","volume-title":"China guidelines for pharmacoeconomic evaluations (2020 english edition)","author":"Liu","year":"2020"},{"key":"B18","unstructured":"Drug pice\n          \n          \n            \n              Yao\n              ZH\n            \n          \n          \n          2025"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1484650","article-title":"Cost-effectiveness analysis of anlotinib plus chemotherapy with or without benmelstobart versus chemotherapy alone for extensive-stage small-cell lung cancer in China","volume":"14","author":"You","year":"2024","journal-title":"Front Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1259574","article-title":"Cost-effectiveness analysis of serplulimab combination therapy versus chemotherapy alone for patients with extensive-stage small cell lung cancer","volume":"13","author":"Zheng","year":"2023","journal-title":"Front Oncol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s12885-018-5237-1","article-title":"Geographical disparities in treatment and health care costs for end-of-life cancer patients in China: a retrospective study","volume":"19","author":"Leng","year":"2019","journal-title":"BMC Cancer"},{"key":"B22","doi-asserted-by":"publisher","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":"B23","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-6-84","article-title":"Health state utilities for non small cell lung cancer","volume":"6","author":"Nafees","year":"2008","journal-title":"Health Qual Life Outcomes"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.2165\/11310250-000000000-00000","article-title":"A decision-theoretic framework for the application of cost-effectiveness analysis in regulatory processes","volume":"27","author":"Baio","year":"2009","journal-title":"Pharmacoeconomics"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0266934","article-title":"Estimating the range of incremental cost-effectiveness thresholds for healthcare based on willingness to pay and GDP per capita: A systematic review","volume":"17","author":"Iino","year":"2022","journal-title":"PloS One"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1080\/16549716.2018.1447828","article-title":"On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review","volume":"11","author":"Cameron","year":"2018","journal-title":"Glob Health Action"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0122760","article-title":"A systematic review of studies eliciting willingness-to-pay per quality-adjusted life year: does it justify CE threshold","volume":"10","author":"Nimdet","year":"2015","journal-title":"PloS One"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s10198-021-01364-3","article-title":"Willingness to pay for a quality-adjusted life year: a systematic review with meta-regression","volume":"23","author":"Kouakou","year":"2022","journal-title":"Eur J Health Econ"},{"key":"B29","doi-asserted-by":"publisher","first-page":"485","DOI":"10.2217\/cer.15.38","article-title":"Systematic overview of cost-effectiveness thresholds in ten countries across four continents","volume":"4","author":"Schwarzer","year":"2015","journal-title":"J Comp Eff Res"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2019.07.009","article-title":"Challenges in the value assessment, pricing and funding of targeted combination therapies in oncology","volume":"123","author":"Dank\u00f3","year":"2019","journal-title":"Health Policy"},{"key":"B31","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s12962-023-00442-y","article-title":"Estimation of the value of curative therapies in oncology: a willingness-to-pay study in China","volume":"21","author":"Huang","year":"2023","journal-title":"Cost Eff Resour Alloc"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2024.01.006","article-title":"Drug pricing, patient welfare, and cost-effectiveness analysis","volume":"27","author":"van Baal","year":"2024","journal-title":"Value Health"},{"key":"B33","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.urolonc.2016.06.003","article-title":"Maximizing resources in the local treatment of prostate cancer: A summary of cost-effectiveness studies","volume":"35","author":"Muralidhar","year":"2017","journal-title":"Urol Oncol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2023.1169752","article-title":"Cost-effectiveness analysis of toripalimab plus chemotherapy versus chemotherapy alone for advanced non-small cell lung cancer in China","volume":"14","author":"Zhang","year":"2023","journal-title":"Front Immunol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1421826","article-title":"Toripalimab plus chemotherapy in the treatment of metastatic triple-negative breast cancer: a cost-effectiveness analysis","volume":"12","author":"Cai","year":"2024","journal-title":"Front Public Health"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1591517\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T05:29:11Z","timestamp":1751347751000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2025.1591517\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":35,"alternative-id":["10.3389\/fimmu.2025.1591517"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2025.1591517","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,1]]},"article-number":"1591517"}}