{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T06:24:26Z","timestamp":1787293466628,"version":"build-2736575974"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"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. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>PD-1\/PD-L1 inhibitors combined with chemotherapy have improved survival outcomes in patients with driver mutation\u2013negative non-squamous non-small cell lung cancer (non-sqNSCLC). However, the comparative efficacy, safety, and economic value of available PD-1\/PD-L1 inhibitor\u2013based regimens remain uncertain in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a network meta-analysis to indirectly compare the efficacy and safety of 14 first-line treatment regimens, including 13 PD-1\/PD-L1 inhibitor\u2013based chemotherapy regimens and chemotherapy alone, in patients with driver mutation\u2013negative non-sqNSCLC. Clinical evidence was subsequently integrated into a Markov model with a 10-year time horizon and 3-week cycles to evaluate cost-effectiveness from the perspective of the Chinese healthcare system. Transition probabilities were derived from reconstructed survival curves using parametric survival models. The primary economic outcomes included total costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and net monetary benefits (NMBs). Deterministic and probabilistic sensitivity analyses were performed to assess model robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The network meta-analysis demonstrated that toripalimab, sintilimab, and pembrolizumab combined with chemotherapy provided superior efficacy and favorable safety among 13 PD-1\/PD-L1 inhibitors with chemotherapy for non-sqNSCLC. In the cost-effectiveness analysis, toripalimab with chemotherapy achieved 2.583 QALYs at a total cost of $39,232.33. And it was cost-effective compared with chemotherapy alone, camrelizumab-, tislelizumab-, and sintilimab-based chemotherapy regimens, with ICERs ranging from $10,624.47 to $16,120.12 per QALY, all below the willingness-to-pay threshold of $41,859\/QALY. Compared with chemotherapy alone, camrelizumab, tislelizumab, sintilimab with chemotherapy were cost-effective, with ICERs of $28,813.78\/QALY, $19,278.47\/QALY, and $20,315.01\/QALY, respectively. PFS and PD utilities were key drivers of cost-effectiveness, while drug costs predominantly influenced regimens with ICERs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among currently available first-line treatment strategies for driver mutation\u2013negative non-sqNSCLC in China, toripalimab and sintilimab combined with chemotherapy demonstrated favorable clinical and economic profiles. These findings provide evidence to support treatment selection, reimbursement decisions, and healthcare resource allocation in clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1849145","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T05:37:47Z","timestamp":1787290667000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing PD-1\/PD-L1 inhibitors plus chemotherapy for driver mutation\u2013negative non-squamous NSCLC in China: a cost-effectiveness analysis"],"prefix":"10.3389","volume":"17","author":[{"given":"Jianwei","family":"Ji","sequence":"first","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, Shannxi, China"]},{"name":"Department of Pharmacy, The Second Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, Shannxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengmeng","family":"Teng","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Second Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuhong","family":"Qin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Second Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruikang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Second Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yalin","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The First Affiliated Hospital of Xi\u2019an Jiaotong University","place":["Xi\u2019an, Shannxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"102065","DOI":"10.1016\/j.esmoop.2023.102065","article-title":"Nivolumab plus chemotherapy in first-line metastatic non-small-cell lung cancer: results of the phase III checkmate 227 part 2 trial","volume":"8","author":"Borghaei","year":"2023","journal-title":"ESMO Open"},{"key":"B2","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. 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