Josh J Carlson1, Kangho Suh2, Panos Orfanos3, William Wong4. 1. University of Washington, 1959 NE Pacific St., H-375I, Box 357630, Seattle, WA, 98195-7630, USA. Carlsojj@u.washington.edu. 2. University of Washington, 1959 NE Pacific St., H-375I, Box 357630, Seattle, WA, 98195-7630, USA. 3. F. Hoffmann-La Roche, Ltd, Basel, Switzerland. 4. Genentech, Inc., South San Francisco, CA, USA.
Abstract
BACKGROUND: The recently completed ALEX trial demonstrated that alectinib improved progression-free survival, and delayed time to central nervous system progression compared with crizotinib in patients with anaplastic lymphoma kinase-positive non-small-cell lung cancer. However, the long-term clinical and economic impact of using alectinib vs. crizotinib has not been evaluated. The objective of this study was to determine the potential cost utility of alectinib vs. crizotinib from a US payer perspective. METHODS: A cost-utility model was developed using partition survival methods and three health states: progression-free, post-progression, and death. ALEX trial data informed the progression-free and overall survival estimates. Costs included drug treatments and supportive care (central nervous system and non-central nervous system). Utility values were obtained from trial data and literature. Sensitivity analyses included one-way and probabilistic sensitivity analyses. RESULTS: Treatment with alectinib vs. crizotinib resulted in a gain of 0.91 life-years, 0.87 quality-adjusted life-years, and incremental costs of US$34,151, resulting in an incremental cost-effectiveness ratio of US$39,312/quality-adjusted life-year. Drug costs and utilities in the progression-free health state were the main drivers of the model in the one-way sensitivity analysis. From the probabilistic sensitivity analysis, alectinib had a 64% probability of being cost effective at a willingness-to-pay threshold of US$100,000/quality adjusted life-year. CONCLUSIONS: Alectinib increased time in the progression-free state and quality-adjusted life-years vs. crizotinib. The marginal cost increase was reflective of longer treatment durations in the progression-free state. Central nervous system-related costs were considerably lower with alectinib. Our results suggest that compared with crizotinib, alectinib may be a cost-effective therapy for treatment-naïve patients with anaplastic lymphoma kinase-positive non-small-cell lung cancer.
BACKGROUND: The recently completed ALEX trial demonstrated that alectinib improved progression-free survival, and delayed time to central nervous system progression compared with crizotinib in patients with anaplastic lymphoma kinase-positive non-small-cell lung cancer. However, the long-term clinical and economic impact of using alectinib vs. crizotinib has not been evaluated. The objective of this study was to determine the potential cost utility of alectinib vs. crizotinib from a US payer perspective. METHODS: A cost-utility model was developed using partition survival methods and three health states: progression-free, post-progression, and death. ALEX trial data informed the progression-free and overall survival estimates. Costs included drug treatments and supportive care (central nervous system and non-central nervous system). Utility values were obtained from trial data and literature. Sensitivity analyses included one-way and probabilistic sensitivity analyses. RESULTS: Treatment with alectinib vs. crizotinib resulted in a gain of 0.91 life-years, 0.87 quality-adjusted life-years, and incremental costs of US$34,151, resulting in an incremental cost-effectiveness ratio of US$39,312/quality-adjusted life-year. Drug costs and utilities in the progression-free health state were the main drivers of the model in the one-way sensitivity analysis. From the probabilistic sensitivity analysis, alectinib had a 64% probability of being cost effective at a willingness-to-pay threshold of US$100,000/quality adjusted life-year. CONCLUSIONS:Alectinib increased time in the progression-free state and quality-adjusted life-years vs. crizotinib. The marginal cost increase was reflective of longer treatment durations in the progression-free state. Central nervous system-related costs were considerably lower with alectinib. Our results suggest that compared with crizotinib, alectinib may be a cost-effective therapy for treatment-naïve patients with anaplastic lymphoma kinase-positive non-small-cell lung cancer.
Authors: Roy S Herbst; Diane Prager; Robert Hermann; Lou Fehrenbacher; Bruce E Johnson; Alan Sandler; Mark G Kris; Hai T Tran; Pam Klein; Xin Li; David Ramies; David H Johnson; Vincent A Miller Journal: J Clin Oncol Date: 2005-07-25 Impact factor: 44.544
Authors: A Guérin; M Sasane; H Wakelee; J Zhang; K Culver; K Dea; R Nitulescu; P Galebach; A R Macalalad Journal: Curr Med Res Opin Date: 2015-06-29 Impact factor: 2.580
Authors: Mark G Kris; Ronald B Natale; Roy S Herbst; Thomas J Lynch; Diane Prager; Chandra P Belani; Joan H Schiller; Karen Kelly; Harris Spiridonidis; Alan Sandler; Kathy S Albain; David Cella; Michael K Wolf; Steven D Averbuch; Judith J Ochs; Andrea C Kay Journal: JAMA Date: 2003-10-22 Impact factor: 56.272
Authors: Ulrich Gatzemeier; Anna Pluzanska; Aleksandra Szczesna; Eckhard Kaukel; Jaromir Roubec; Flavio De Rosa; Janusz Milanowski; Hanna Karnicka-Mlodkowski; Milos Pesek; Piotr Serwatowski; Rodryg Ramlau; Terezie Janaskova; Johan Vansteenkiste; Janos Strausz; Georgy Moiseevich Manikhas; Joachim Von Pawel Journal: J Clin Oncol Date: 2007-04-20 Impact factor: 44.544
Authors: Ryohei Katayama; Luc Friboulet; Sumie Koike; Elizabeth L Lockerman; Tahsin M Khan; Justin F Gainor; A John Iafrate; Kengo Takeuchi; Makoto Taiji; Yasushi Okuno; Naoya Fujita; Jeffrey A Engelman; Alice T Shaw Journal: Clin Cancer Res Date: 2014-09-16 Impact factor: 12.531
Authors: Woojung Lee; William B Wong; Stacey Kowal; Louis P Garrison; David L Veenstra; Meng Li Journal: Pharmacoeconomics Date: 2022-05-09 Impact factor: 4.558
Authors: Ernest Nadal; Dolores Bautista; Luis Cabezón-Gutiérrez; Ana Laura Ortega; Héctor Torres; David Carcedo; Lucía Ruiz de Alda; J Francisco Garcia; Paula Vieitez; Federico Rojo Journal: BMC Cancer Date: 2021-06-10 Impact factor: 4.430