Cost-effectiveness analysis of alectinib versus crizotinib in first-line treatment of anaplastic lymphoma kinase-positive advanced non-small cell lung cancer

  • Ravasio R Health Publishing & Services Srl, Milano, Italia
  • Tiseo M Dipartimento Medicina e Chirurgia, Università degli Studi di Parma e U.O. Oncologia Medica, Azienda Ospedaliero-Universitaria di Parma, Parma, Italia
  • Pradelli L AdRes, Health Economics & Outcome Research, Torino, Italia
  • Bellone M AdRes, Health Economics & Outcome Research, Torino, Italia
  • Gervasi A Roche S.p.A., Monza, Italia
  • Coffani M Roche S.p.A., Monza, Italia
Keywords: Alectinib, crizotinib, NSCLC, ALK-positive, cost-utility, Italian NHS

Abstract

In the randomized, active-controlled, multicenter Phase III open-label ALEX trial, alectinib showed superior efficacy and lower toxicity compared with crizotinib in the primary treatment of anaplastic lymphoma kinase-positive non-small cell lung cancer (ALK-positive NSCLC). The aim of this economic evaluation was to assess the cost-utility of alectinib versus crizotinib from the perspective of the Italian National Health Service (INHS). A partitioned survival model with three health states (progression-free, post-progression, and death) was used. The clinical data (progression-free survival, overall survival and time to progression) was based on the ALEX trial. Utility values were derived from EQ-5D scores evaluated in the ALEX trial and literature. Costs included drug treatments, progression-free, post-progression and supportive care. Direct medical costs and benefits (quality-adjusted life-years, QALYs) were discounted at a 3.0% annual rate. Uncertainty was assessed using deterministic and probabilistic sensitivity analyses. Treatment with alectinib versus crizotinib led to a gain of 2.82 life-years, 1.86 QALYs, and incremental costs of €58,276, resulting in an incremental cost-utility ratio of €31,353 per QALY. The deterministic analysis showed that the most critical parameters in the model were the cost of post-progression and utility scores. From the probabilistic sensitivity analysis, alectinib had a 64.5% probability of being cost-effective at a willingness-to-pay threshold of €40,000 per QALY. Compared with crizotinib, alectinib increased the length of the progression-free state and the QALYs. The incremental overall cost increase was reflective of longer treatment durations in the progression-free state. Compared with crizotinib, alectinib can be considered a valid cost-utility option in the treatment of naive patients with ALK-positive NSCLC.
Published
2019-06-13
How to Cite
RR., MT., LP., MB., AG., & MC. (2019). Cost-effectiveness analysis of alectinib versus crizotinib in first-line treatment of anaplastic lymphoma kinase-positive advanced non-small cell lung cancer. Global & Regional Health Technology Assessment, 6(1). https://doi.org/10.33393/grhta.2019.462
Section
Original Research Article