Yumei Zhu

Objective: To develop a multi‐stakeholder, consensus‐based decision support framework for prioritizing innovative anticancer drugs in Chinese hospital formularies, balancing clinical benefit, patient access, and financial sustainability. Methods: A two‐round Delphi survey was conducted with a multidisciplinary expert panel ( n = 62 in Round 1; n = 51 in Round 2, 82.3% retention rate) comprising clinicians, pharmacists, health administrators, and patient representatives. The initial set of 19 indicators across 9 dimensions, derived from a literature review, was iteratively refined based on panel feedback. Consensus was defined as ≥ 80% of respondents rating an indicator as 4 or 5 on a 5‐point Likert scale, dispersion was summarized by interquartile range (IQR). Results: The panel reached a clear consensus on a structured framework comprising seven key dimensions and 16 measurable indicators. The top three prioritized dimensions were clinical benefits, safety, and economic impact. The framework incorporates policy‐sensitive indicators relevant to China's healthcare system, such as pharmaceutical access and access barriers of genetic testing. Five indicators from the initial list were discarded, and two new ones were added based on expert input, with specific metrics refined for enhanced objectivity and practicality (e.g., “patient out‐of‐pocket expenditure per year”). Conclusion: This study presents a transparent, standardized, and actionable decision‐making framework to support formulary selection of innovative anticancer drugs in Chinese hospitals—particularly in resource‐adequate settings. By incorporating diverse stakeholder perspectives and establishing clear evaluation criteria, the framework reduces subjectivity and supports consistent value assessment. It provides practical guidance for hospital pharmacy and therapeutics committees and contributes to more equitable, evidence‐informed, and financially sustainable drug policy development in China. Patient or Public Contribution: Patient representatives participated in the first‐round expert panel, where they rated candidate indicators, shared their lived experiences, and provided feedback on the interview guides and questionnaires.

Background: As the first domestic PD-1 antibody approved for lung cancer in China, camrelizumab has exhibited proven effectiveness for non-small-cell lung cancer (NSCLC) patients. However, the cost-effectiveness of this new regimen remains to be investigated.Objective: To evaluate the cost-effectiveness of camrelizumab combination therapy vs. chemotherapy for previously untreated patients with advanced, non-squamous NSCLC without Alk or Egfr genomic aberrations from the perspective of China's healthcare system.Methods: Based on the CameL trial, the study developed a three-health state Markov model to evaluate the cost-effectiveness of adding camrelizumab to chemotherapy compared to chemotherapy alone in NSCLC patients. The analysis models were conducted for patients unselected by PD-L1 tumor expression (the base case) and the patient subgroup with PD-L1-expressing tumors (≥1%). Primary model outcomes included the costs in US dollars and health outcomes in quality-adjusted life-years (QALYs) as well as the incremental cost-effectiveness ratio (ICER) under a willingness-to-pay threshold of $31,500 per QALY. Additionally, a scenario analysis that adjusted within-trial crossover was employed to evaluate camrelizumab combination therapy compared to chemotherapy without subsequent use of PD1/PD-L1 antibodies.Results: Camrelizumab combination therapy was more costly and provided additional 0.11 QALYs over chemotherapy in the base case analysis (0.86 vs. 0.75 QALYs), 0.12 QALYs over chemotherapy in the subgroup analysis (0.99 vs. 0.88 QALYs), and 0.34 QALYs over chemotherapy in the scenario analysis (0.86 vs. 0.52 QALYs). Correspondingly, the ICER was $63,080 per QALY, $46,311 per QALY, and $30,591 per QALY, in the base case, the subgroup, and the scenario analysis, respectively. One-way sensitivity analyses revealed that ICERs of the base case and the subgroup analysis were most sensitive to the cost of camrelizumab, the cost of pemetrexed. Besides, the base case and subgroup analysis were more sensitive to the risk of neutrophil count decreased in the camrelizumab and the utility of stable disease, respectively.Conclusion: Although camrelizumab combination therapy is not cost-effective as first-line therapy for NSCLC patients in China in the base case, adjusting within-trial crossover would move the treatment regimen toward cost-effectiveness in the scenario analysis.

To evaluate the cost-effectiveness of durvalumab in post-chemoradiotherapy patients with unresectable stage III NSCLC from the Chinese healthcare system perspective.The study developed a five-healt...

Objective: To assess the cost-effectiveness of atezolizumab in combination with carboplatin plus nab-paclitaxel-based chemotherapy versus chemotherapy alone for first-line treatment of advanced non-squamous non-small cell lung cancer (NSCLC) from the Chinese healthcare system perspective. Methods: A Markov model was developed based on the IMpower130 clinical trial. Drug costs and health state utility were obtained from the literature. Outcomes included life-years (LYs), quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratio (ICER). One-way and probabilistic sensitivity analyses were performed to evaluate the model uncertainty. Results: When compared to chemotherapy alone, atezolizumab plus chemotherapy provides an additional 0.34 LY and 0.19 QALY, and has an ICER of $180,560.15 per additional LY gained and that of $325,328.71 per QALY gained. Sensitivity analysis revealed that the results were most sensitive to changes in atezolizumab cost. Probabilistic sensitivity analysis showed that there was a 0% probability that atezolizumab plus chemotherapy was cost-effective at willingness-to-pay values of $30,828 per QALY. If the WTP threshold increased to $325,000 per QALY, atezolizumab plus chemotherapy has a 50% chance to be cost-effective. Conclusions: From the Chinese healthcare system perspective, atezolizumab combination is not cost-effective for first-line therapy of advanced non-squamous NSCLC.

Summary: China's population is aging rapidly, while the traditional long‐term care (LTC) system that heavily relies on families is eroding. In response, China has embarked on a journey of policy experimentation for long‐term care insurance (LTCI) since 2016, launching LTCI pilots in 15 pioneer cities. These pilots have a great diversity in participation, eligibility, and provision. This paper estimates the prevalence of LTC needs and analyzes the impact of the LTCI pilots on access. Although substantial progress has been achieved, the overall coverage of LTCI is still relatively small, and a large proportion of vulnerable people needing LTC seem to be left behind because of the strict eligibility criteria. This analysis suggests that future policy experimentation on LTCI reform in China needs to address the following pressing policy issues: expanding the coverage of LTCI; narrowing rural–urban disparities in access; improving access for vulnerable subpopulations; and reducing the heavy reliance on institutional care.