Ivonescimab for lung cancer fails cost-effectiveness test in China at current prices

A new economic evaluation published in BMC Health Services Research concludes that ivonescimab plus chemotherapy, an emerging first-line option for advanced squamous non-small cell lung cancer (NSCLC), is not a cost-effective treatment at its current market price from the perspective of the Chinese healthcare system. The study, authored by Jun Xu, Jinlong Huang, Xiaochun Zheng and Bin Wan, compared the ivonescimab-based regimen against tislelizumab plus chemotherapy. The analysis addresses a question the authors identify as unresolved: while innovative dual-targeted agents such as ivonescimab hold promise for enhancing patient outcomes in China, their substantial financial burden raises critical questions regarding economic viability and value.

The researchers built their model on clinical data from HARMONi-6, a published randomized controlled trial that tested ivonescimab plus chemotherapy as first-line treatment for advanced squamous NSCLC. Using a decision-analytic Markov model, they projected long-term economic and health outcomes over a 10-year time horizon, tracking three primary outcomes: life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). To test the robustness of the model and address parameter uncertainty, the team performed univariate sensitivity analyses, probabilistic sensitivity analyses (PSA), and scenario analyses.

The results quantify a substantial mismatch between benefit gained and cost incurred. Compared with the tislelizumab combination, ivonescimab plus chemotherapy yielded an incremental 0.1947 QALYs, resulting in an ICER of $279,130.24 per QALY. Against a willingness-to-pay threshold of $43,969.85 per QALY, the ivonescimab-based therapy was not economically viable.

The incremental quality-adjusted benefit was modest, while the incremental cost per QALY far exceeded the designated threshold. The univariate sensitivity analyses pinpointed where the economics were most fragile. The model was highly sensitive to three parameters: the cost of ivonescimab itself, the utility value assigned to progression-free disease, and the disutility associated with adverse events in the ivonescimab arm.

The probabilistic sensitivity analysis, which samples across the uncertainty ranges of the model inputs, confirmed the headline finding: the probability that ivonescimab plus chemotherapy would be cost-effective at the designated threshold was 0%. Price simulation analysis, however, revealed how pricing could change the picture. When the researchers modeled a 68% reduction in the price of ivonescimab, bringing the cost to $108.23 per vial, the probability of cost-effectiveness rose to 0.20%, still negligible.

But at an 84.5% price reduction, equivalent to $52.40 per vial, the regimen became 99% cost-effective under the same threshold. The magnitude of the required reduction illustrates the scale of the affordability gap between the drug's current price and the threshold used in the analysis. The authors' conclusion is stated conditionally rather than as a flat rejection.

From the perspective of the Chinese healthcare system, first-line ivonescimab plus chemotherapy for advanced squamous NSCLC is not a cost-effective alternative at its current market price. Nevertheless, they write, with the support of national medical insurance policies and the implementation of drug price reduction strategies, this innovative bispecific antibody therapy is expected to achieve affordability and economic value within China's healthcare system. The choice of comparator matters for interpreting the result.

Tislelizumab plus chemotherapy served as the reference regimen in the model, so the ICER captures the incremental economics of switching first-line therapy from the tislelizumab combination to the ivonescimab combination for this patient population, rather than the absolute value of either regimen in isolation. The 0.1947 QALY increment and the associated ICER therefore describe the marginal trade-off between the two combinations as modeled from the HARMONi-6 clinical inputs. For policymakers, the practical takeaway is that the modeled economics of ivonescimab in this setting depend overwhelmingly on price.

The sensitivity analyses identified the drug's cost as a dominant driver of the result, and the price simulations quantified the reductions at which the regimen would cross the cost-effectiveness threshold. Until pricing aligns with the levels modeled here, the regimen remains, on this analysis, economically out of reach for routine first-line use in China's healthcare system, while the authors' stated expectation is that insurance policy support and price reduction strategies could make the therapy affordable and economically valuable within that system.

Subject of Research: Cost-effectiveness analysis of Ivonescimab plus chemotherapy as first-line treatment for advanced squamous non-small-cell lung cancer in China

Article Title: Cost-effectiveness analysis of Ivonescimab plus chemotherapy as first-line treatment for advanced squamous non-small-cell lung cancer in China

Article References: Xu, J., Huang, J., Zheng, X., & Wan, B. (2026). Cost-effectiveness analysis of Ivonescimab plus chemotherapy as first-line treatment for advanced squamous non-small-cell lung cancer in China. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15929-6

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15929-6

Keywords: Cost-effectiveness, analysis, Ivonescimab, plus, chemotherapy, first-line, treatment, advanced, squamous, non-small-cell, lung, cancer