This study was aimed to evaluate the cost-effectiveness of the recently approved first-line treatments, toripalimab or camrelizumab combined with gemcitabine plus cisplatin2 (GP) and GP alone for patients with recurrent or metastatic nasopharyngeal carcinoma3 (RM-NPC) from the Chinese payers' perspective.We established a Markov model to estimate the cost and effectiveness of currently first-line therapies for RM-NPC. Survival data were derived from the CAPTAIN-1st and JUPITER-02 trials. Direct medical costs and utilities were collected from the published literature and standard fee database. Main outcomes were total costs, quality-adjusted life-year4 (QALY), and incremental cost-effectiveness ratios (ICER) at a willingness-to-pay5 (WTP) of $34 066/QALY. The robustness of the model was assessed by performing one-way and probability sensitivity analyses.Compared with the GP chemotherapy, toripalimab or camrelizumab plus GP chemotherapy as first-line therapy for RM-NPC provided an incremental cost of $6 026 and $43 138 with additional 0.90 QALYs and 0.78 QALYs, respectively, resulting in an ICER of 6 696 $/QALY and 55 305 $/QALY. In the pairwise comparison between the two immunotherapy-related groups, toripalimab plus GP was the dominant strategy with lower costs and higher efficiency than the camrelizumab plus GP group.In our analysis, compared with GP chemotherapy alone, toripalimab plus GP was more cost-effective, while camrelizumab plus GP chemotherapy was not cost-effective. In the pairwise comparison between the two immunotherapy-related groups, toripalimab plus GP would be more cost-effective than camrelizumab plus GP chemotherapy.Copyright © 2022. Published by Elsevier Ltd.