Cost-effectiveness analysis based on two models of sacituzumab tirumotecan versus platinum-based chemotherapy as second-line treatment in EGFR-mutant non-small-cell lung cancer

Background: For patients with advanced EGFR-mutant non-small cell lung cancer (NSCLC) who progress after first-line therapy, effective subsequent options are urgently needed. From the perspective of China's healthcare system, this study evaluated the cost-effectiveness of sacituzumab tirumotecan (sac-TMT) versus conventional platinum-based chemotherapy, using both a partitioned survival model (PSM) and a Markov model. Methods: Clinical efficacy and safety data were derived from the OptiTROP-Lung04 trial. Key health economic outcomes included direct medical costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). Model robustness was tested via one-way and probabilistic sensitivity analyses (OWSA, PSA), plus scenario analysis. Results: In the PSM, sac-TMT incurred an incremental cost of $64,948.58 and a gain of 0.74 QALYs versus chemotherapy, yielding an ICER of $87,922.33/QALY. The Markov model showed similar trends: an incremental cost of $52,075.41 for 0.67 QALYs, with an ICER $78,131.64/QALY-both far above the willingness-to-pay threshold (3 × 2025 GDP per capita). OWSA identified key drivers (e.g., progression free survival utility, progressive disease utility, sac-TMT price, the incidence of neutropenia in the sac-TMT arm), and base-case results remained stable within reasonable ranges. Notably, PSA revealed a 0% probability of sac-TMT being cost-effective under the current threshold. Scenario analysis indicated that including sac-TMT in medical insurance or raising the payment threshold could make cost-effectiveness feasible (up to 100% probability). Conclusion: In China's healthcare setting, sac-TMT is not cost-effective for second line treatment of advanced EGFR-mutant NSCLC compared with platinum-based chemotherapy. To improve patient access, substantial price reductions or inclusion in the National Reimbursement Drug List are necessary. These findings may inform both clinical decisions and health resource allocation.