Ivonescimab Plus Chemotherapy Fails Cost-Effectiveness Test in Advanced Squamous Lung Cancer

A new pharmacoeconomic analysis has found that adding the bispecific antibody ivonescimab to chemotherapy as a first-line treatment for advanced squamous non-small cell lung cancer (NSCLC) is unlikely to offer good value for money, either in China or in the United States, despite the regimen’s impressive clinical performance in the HARMONi-6 trial. Researchers from The First Affiliated Hospital of Xiamen University and Fudan University Zhongshan Hospital Xiamen Branch built a partitioned survival model in TreeAge Pro to project the disease trajectory and healthcare resource use of patients over a 10-year horizon. They fitted and extrapolated the survival curves reported in the HARMONi-6 trial, calculated direct medical costs, and compared the incremental cost-effectiveness ratio (ICER) of ivonescimab plus chemotherapy against a tislelizumab-based chemotherapy regimen, judged against standard willingness-to-pay (WTP) thresholds.

In the Chinese healthcare system perspective, the ivonescimab group accumulated total costs of $60,942 for 2.33 quality-adjusted life years (QALYs), while the tislelizumab group cost $30,093 for 1.57 QALYs. The resulting ICER of $40,328 per QALY gained exceeded the willingness-to-pay benchmarks used in China, which are anchored to multiples of the per-capita GDP. Under the unified model framework of the study, the authors concluded that the ivonescimab regimen is unlikely to hold a cost-effectiveness advantage over the tislelizumab regimen as first-line therapy for advanced squamous NSCLC in that setting.

Sensitivity analyses identified utility during progressive disease as the most influential parameter driving the Chinese results, meaning that how much quality of life patients retain after their cancer progresses matters more to the economic verdict than most other model inputs. The team also ran threshold analyses to estimate the theoretical price at which ivonescimab would become cost-effective. Those thresholds came out at $27.85 per 100 mg, $67.63 per 100 mg, and $107.40 per 100 mg, corresponding to willingness-to-pay levels of one, two, and three times the per-capita GDP, respectively.

The U.S. scenario told a similar story at a much larger monetary scale. Total costs reached $572,981 for the ivonescimab arm versus $419,922 for the comparator, while health outcomes were 3.16 QALYs and 2.19 QALYs respectively. The ICER of $157,444 per QALY sat above the commonly cited American thresholds of $100,000 and $150,000 per QALY, again leaving the ivonescimab regimen on the unfavorable side of the cost-effectiveness line.

In the U.S. model, ivonescimab’s price was the dominant driver of the ICER. The theoretical cost-effective price thresholds in the American scenario were $609.10 per 100 mg at a $100,000-per-QALY willingness-to-pay and $777.31 per 100 mg at $150,000 per QALY, figures far above the price levels assumed for the Chinese market. The clinical backdrop is the HARMONi-6 trial, which showed outstanding efficacy for ivonescimab plus chemotherapy in advanced squamous NSCLC.

In China, thresholds tied to per-capita GDP are used to judge whether new therapies represent efficient use of limited healthcare funds, while U.S. evaluations often reference the $100,000 to $150,000 per QALY range. A drug can be clinically superior and still fail these tests if its price outpaces the size of the benefit, which is precisely the situation the modelers found for ivonescimab in both systems. The study, published in Frontiers in Pharmacology in the section on pharmacoeconomics, drug access and value assessment, also carries the usual caveats of model-based economic evaluation.

As with any modeling exercise, the findings represent projections under stated assumptions rather than observed billing data from treated patients. For clinicians, payers, and manufacturers, the practical takeaway is the price arithmetic. In China, ivonescimab would need to fall to roughly $28 to $107 per 100 mg depending on how generously society values a QALY; in the U.S., thresholds of roughly $609 to $777 per 100 mg would be required.

Until pricing approaches those levels, the analysis suggests the regimen’s striking clinical gains in advanced squamous NSCLC come at a cost that neither health system’s standard benchmarks would currently endorse.

Subject of Research: Cost-effectiveness of ivonescimab plus chemotherapy versus tislelizumab for advanced squamous non-small cell lung cancer

Article Title: Cost-effectiveness analysis of ivonescimab plus chemotherapy in advanced squamous NSCLC: a Chinese healthcare system perspective with U.S. pricing scenario exploration

Article References: Zheng, L., Chen, F., Zhong, K., & Yang, J. (2026). Cost-Effectiveness Analysis of Ivonescimab Plus Chemotherapy in Advanced Squamous NSCLC: A Chinese Healthcare System Perspective with U.S. Pricing Scenario Exploration. Frontiers in Pharmacology, 17, 1942976. https://doi.org/10.3389/fphar.2026.1942976

Image Credits: AI Generated

DOI: 10.3389/fphar.2026.1942976

Keywords: ivonescimab, tislelizumab, non-small cell lung cancer, cost-effectiveness, HARMONi-6 trial, ICER, QALY, pharmacoeconomics, chemotherapy, willingness-to-pay, drug pricing, partitioned survival model