目的 从我国卫生体系角度出发，评价依沃西单抗联合化疗治疗表皮生长因子受体（EGFR）突变晚期非小细胞肺癌（NSCLC）的经济性。方法 基于HARMONi-AⅢ期临床研究数据，建立Markov模型模拟疾病进展状态，模拟研究时限为10年，21 d为1个周期，以质量调整生命年（QALYs）为健康产出指标，成本和健康产出采用5%贴现率进行贴现，计算增量成本-效果比（ICER）值作为基础结果，并与意愿支付值（WTP）进行对照比较，采用敏感性分析验证模型的稳健性。结果 基础结果分析显示，依沃西单抗组的ICER值为664 342.27元/QALY，增量成本为141 825.71元，增量效用为0.22QALYs,ICER值高于阈值287 100元/QALY，从单因素敏感分析中，可知无进展生存期（PFS）效用值和依沃西单抗的价格对ICER值影响最大；从概率敏感性分析中可知当WTP为2024年我国人均国内生产总值的3倍即287 100元时，依沃西单抗联合化疗治疗EGFR突变晚期NSCLC不具有经济性。结论 在WTP阈值为我国2024人均GDP 3倍时，依沃西单抗联合化疗相比单纯化疗治疗EGFR突变晚期NSCLC不具有经济性。

Objective From the perspective of China’s health system, to evaluate the economic feasibility of using ivonescimab plus combination chemotherapy for the treatment of EGFR variant non-small cell cancer（NSCLC）. Methods Based on the Phase 3 clinical study data of HARMONI-A, a Markov model was established to simulate disease progression status, simulation research with a time limit of 10 years and 21 d per cycle. Quality adjusted life years（QALYs） were used as health output indicators, and the cost and health outputs are discounted at a 5% discount rate. The incremental cost-effectiveness ratio（ICER） value was calculated as the basic result and compared with the willingness to pay（WTP） value. Sensitivity analysis was used to verify the robustness of the model. Results The basic result analysis showed that the ICER value of the ivonescimab group was 664 342.27 yuan/QALY, with an incremental cost of 141 825.71 yuan and an incremental utility of 0.22 QALYs. The ICER value was much higher than the threshold of 287 100 yuan/QALY. From the single factor sensitivity analysis, it can be concluded that the PFS utility value and the price of ivonescimab have the greatest impact on the ICER value; From the probability sensitivity analysis, it can be seen that when the WTP is 3 times of China’s per capita gross domestic product（287 100 yuan） in 2024, there is no economics for ivonescimab plus chemotherapy in the treatment of EGFR mutated advanced non-small cell lung cancer. Conclusion When the WTP threshold is three times the per capita GDP of China in 2024, compared with chemotherapy treatment, ivonescimab combined with chemotherapy is not cost-effective for EGFR-mutated advanced NSCLC.

R974