{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:03:49Z","timestamp":1784783029055,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"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>Immunotherapy combined with anti-angiogenic agents and chemotherapy has emerged as a novel therapeutic option for non-squamous non-small cell lung cancer (non-sqNSCLC) after resistance to tyrosine kinase inhibitors (TKIs). This study evaluated the efficacy, safety, and cost-effectiveness of these regimens in patients with TKI-resistant non-sqNSCLC in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A network meta-analysis was performed to compare the efficacy and safety of ivonescimab plus chemotherapy (Ivon-Chem), sintilimab plus bevacizumab and chemotherapy (Sint-Beva-Chem), and atezolizumab plus bevacizumab and chemotherapy (Atez-Beva-Chem). A Markov model was constructed to assess the cost-effectiveness of Ivon-Chem, Sint-Beva-Chem, Atez-Beva-Chem, and chemotherapy until the survival probability fell below 1% in any regimen. The incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB) were estimated using a willingness-to-pay (WTP) threshold of $41,859. Sensitivity analyses and scenario simulations were also performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ivon-Chem, Sint-Beva-Chem, and Atez-Beva-Chem improved efficacy but were associated with poorer safety profiles than chemotherapy. Compared with chemotherapy, Ivon-Chem, Sint-Beva-Chem, and Atez-Beva-Chem were not cost-effective, with ICERs of $61,882.3\/QALY, $68,657.0\/QALY, and $188,820.5\/QALY, respectively. Moreover, the NMBs of Ivon-Chem, Sint-Beva-Chem and Atez-Beva-Chem were all negative, indicating that none of these regimens was economically acceptable. Scenario analyses indicated that, compared with chemotherapy, Ivon-Chem would become cost-effective if the price of ivonescimab were reduced by at least 47.2%. Similarly, Sint-Beva-Chem and Atez-Beva-Chem would achieve cost-effectiveness following price reductions of 59.3% for both sintilimab and bevacizumab, and 84.4% for both atezolizumab and bevacizumab, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These immunotherapy-based regimens provided significant survival benefits in patients with TKI-resistant non-sqNSCLC. However, from the perspective of the Chinese healthcare system, Ivon-Chem, Sint-Beva-Chem, and Atez-Beva-Chem were not cost-effective. Substantial price reductions would be required to improve their economic viability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1860791","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:31:14Z","timestamp":1784781074000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost-effectiveness analysis of combined immunotherapy regimens for non-squamous non-small lung cancer after tyrosine kinase inhibitors resistance"],"prefix":"10.3389","volume":"14","author":[{"given":"Mengmeng","family":"Teng","sequence":"first","affiliation":[{"name":"Department of Pharmacy, The Second Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Statistics, School of Public Health, Fudan University","place":["Shanghai, 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, 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, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianwei","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Second Affiliated Hospital of Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.jncc.2024.01.006","article-title":"Cancer incidence and mortality in China, 2022","volume":"4","author":"Han","year":"2024","journal-title":"J Natl Cancer Cent"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1002\/cac2.12359","article-title":"Non-small cell lung Cancer in China","volume":"42","author":"Chen","year":"2022","journal-title":"Cancer Commun"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"191","DOI":"10.20892\/j.issn.2095-3941.2024.0592","article-title":"Chinese Society of Clinical Oncology non-Small Cell Lung Cancer (CSCO NSCLC) guidelines in 2024: key update on the management of early and locally advanced NSCLC","volume":"22","author":"Chen","year":"2025","journal-title":"Cancer Biol 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