Objective  From the perspective of the Chinese health system, to evaluate the economics of using anlotinib compared to placebo in the third line treatment of advanced non-small cell lung cancer, and provide a reference for the rational clinical application of anlotinib and evidence-based medical insurance decision-making.

Methods  Using clinical trial data and relevant literature data, TreeAge Pro 2022 software was used to establish a Markov model for the treatment of advanced non-small cell lung cancer with anlotinib. The model had a 3-week cycle and a simulation time limit of 10 years. The cost and utility values were discounted using a 5% discount rate to determine the cost, life years, and quality adjusted life years (QALYs) of the two regimens, the model used the incremental cost utility ratio (ICUR) as the evaluation indicator. Using three times China's per capita GDP in 2022 (257 094 yuan/QALY) as the willingness to pay threshold (WTP) for pharmacoeconomic evaluation to determine the economic viability of the two options. Single factor sensitivity analysis and probability sensitivity analysis were conducted to determine the impact of parameter changes on the robustness of model results.

Results  After 10 years of model simulation, the cost of the anlotinib group was 79 919.41 yuan, while the total cost of the placebo group was 21 938.43 yuan. The anlotinib group could obtain 1.78 life years and 0.8 QALYs, while the placebo group could obtain 0.96 life years and 0.39 QALYs. The ICUR value of the two groups compared was 141 417.02 yuan/QALY, far lower than the willingness to pay threshold in China (257 094 yuan/QALY). The results of the single factor sensitivity analysis showed that the utility value in the state of no progress and the price of anlotinib were the most significant factors affecting the results. The probability sensitivity analysis results showed that when the threshold was 257 094 yuan/QALY, the probability of economic viability of the Anlotinib group was 100%.

Conclusion  Anlotinib is more cost-effective than placebo in the third line treatment of advanced non-small cell lung cancer patients in China.

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