{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:13:39Z","timestamp":1783660419608,"version":"3.55.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The FL-ALTER study introduces a novel first-line therapeutic approach for patients with EGFR mutation-positive advanced non-small cell lung cancer (NSCLC). This study aimed to evaluate the cost-effectiveness of first-line gefitinib plus anlotinib for Chinese patients diagnosed with stage IIIB\u2013IV EGFR-mutant NSCLC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A combined decision-tree and Markov model was constructed to predict 5-year cost-effectiveness using follow-up data from the FL-ALTER trial. Efficacy and safety inputs were derived from randomized clinical trials, whereas cost and utility values were sourced from published literature. Incremental cost-effectiveness ratios (ICERs) were calculated from the perspective of the Chinese healthcare system. Furthermore, scenario analyses were performed to evaluate the economic impact of patient assistance programs (PAPs) and drug price negotiations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with gefitinib plus placebo, first-line gefitinib plus anlotinib yielded an additional 0.16 quality-adjusted life years (QALYs), with an incremental cost-effectiveness ratio (ICER) of $196,652.56\/QALY. Deterministic sensitivity analysis revealed that the utility of progression-free survival and the cost of anlotinib were the most influential parameters driving the model outcomes. Probabilistic sensitivity analysis indicated that the combination regimen had no cost-effectiveness advantage at the current Chinese willingness-to-pay (WTP) threshold of $38,043.34\/QALY.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Within the Chinese healthcare system, first-line gefitinib plus anlotinib is not cost-effective for advanced EGFR-mutated NSCLC at a WTP threshold of $38,043.34\/QALY. However, implementing a PAP or price negotiation for anlotinib could effectively lower incremental costs, rendering this regimen a more economically viable clinical option.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1840381","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T04:24:08Z","timestamp":1783657448000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness analysis of first-line gefitinib plus anlotinib treatment for patients with stage IIIB\u2013IV EGFR-mutated NSCLC in China"],"prefix":"10.3389","volume":"14","author":[{"given":"Ping","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China","place":["Chengdu, 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University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanmei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuyue","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dandan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Sichuan Clinical Research 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