目标：本研究旨在从中国医疗保健系统角度，研究所有可用PD-1抑制剂联合化疗在晚期食管鳞癌（ESCC）一线治疗中的成本效益。方法：基于网络荟萃分析构建一个分段存活模型，采用3周周期和10年时间跨度。生存数据和效用价值来自于临床试验，直接医疗成本来自于公共药品招标数据库和发表的文献。计算总成本、经济适用性生命年（QALY）和边际成本效果比（ICER）。进行情景、单向和概率敏感性分析，评估模型参数的不确定性。结果：与单一化疗相比，托瑞帕利单抗、信迪利单抗和卡瑞利珠单抗加化疗是有成本效益的治疗方案；而塞瑞普利单抗、帕博利珠单抗和尼伏单抗加化疗并不是有成本效益的选择。托瑞帕利单抗加化疗提供了0.95的最高QALY和更低的成本，为其他竞争性方案所不能比。情景和单向敏感度分析证实了基础案例结果的稳健性。在2021年人均国内生产总值（38351.20美元）的三倍意愿支付阈值下，托瑞帕利单抗加化疗是最优选择的概率为74.25%，比其他六个竞争方案更优。结论：托瑞帕利单抗加化疗是中国晚期ESCC患者的一线治疗中最具成本效益的选择。版权所有 ©2023 Liu、Dou和Li。

Objective: This study was aimed to investigate the cost-effectiveness of all available programmed death 1 (PD-1) inhibitors combined with chemotherapy in the first-line treatment of advanced esophageal squamous-cell carcinoma (ESCC) from the Chinese healthcare system perspective. Methods: A partitioned survival model with a 3-week cycle and a 10-year time horizon was constructed based on a network meta-analysis. The survival data and utility values were derived from clinical trials, and the direct medical costs were collected from public drug bidding database and published literature. Total costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) were calculated. Scenario, one-way and probabilistic sensitivity analyses were performed to assess the uncertainty around model parameters. Results: Compared with mono-chemotherapy, toripalimab, sintilimab and camrelizumab plus chemotherapy were cost-effective treatment regimens, while serplulimab, pembrolizumab and nivolumab plus chemotherapy were not cost-effective options. Toripalimab plus chemotherapy provided the highest QALYs of 0.95 with the lower cost of $8,110.53 compared to other competing alternatives. The robustness of the base-case results was confirmed by scenario and one-way sensitivity analysis. At a willingness-to-pay threshold of three times per capita gross domestic product ($38,351.20) in 2021, the probability of toripalimab plus chemotherapy being the optimal option was 74.25% compared with other six competing alternatives. Conclusion: Toripalimab plus chemotherapy represented the most cost-effective option as the first-line therapy for advanced ESCC patients in China.Copyright © 2023 Liu, Dou and Li.