Cost-effectiveness analysis of ceritinib vs. crizotinib in previously untreated anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) in Hong Kong

Abstract

Introduction Lower-dose ceritinib (450 mg) once-daily with food was approved in 2018 in Hong Kong (HK) for first-line treatment of patients with anaplastic lymphoma kinase-positive (ALK +) advanced non-small cell lung cancer (NSCLC). This study examined the cost-effectiveness of ceritinib vs. crizotinib in the first-line treatment of ALK + NSCLC from a HK healthcare service provider's or government's perspective. Methods Costs and effectiveness of first-line ceritinib vs. crizotinib over a 20-year time horizon was evaluated using a partitioned survival model with three health states (stable disease, progressed disease, and death). The efficacy data for ceritinib were obtained from a phase 3 trial comparing ceritinib with chemotherapy for advanced non-small cell lung cancer (ASCEND-4) and extrapolated using parametric survival models. Long-term survival associated with crizotinib were estimated using hazard ratio of crizotinib vs. ceritinib obtained from matching-adjusted indirect comparison based on ASCEND-4 and PROFILE 1014 trials. Drug acquisition, administration, adverse events costs, and medical costs associated with each health state were obtained from public sources and converted to 2018 US Dollars. Incremental costs per quality-adjusted-life-year (QALY) and life-year (LY) gained were estimated for ceritinib vs. crizotinib. Results The base case results showed that ceritinib was associated with 3.22 QALYs, 4.51 LYs, and total costs of $157,581 over 20 years. Patients receiving crizotinib had 2.68 QALYs, 3.85 LYs, and $150,424 total costs over the same time horizon. The incremental cost per QALY gained for ceritinib vs crizotinib was $13,343. Results were robust to deterministic sensitivity analyses in most scenarios. Conclusion Ceritinib offers a cost-effective option compared to crizotinib for previously untreated ALK + advanced NCSLC in HK.

Economic Evaluation of Targeted Therapies for Anaplastic Lymphoma Kinase– and ROS1 Fusion–Positive Non–Small Cell Lung Cancer in India

“… 40 - 43 Similarly, for ceritinib, studies report QALYs ranging from 2.7 to 3.22 in patients with ALK -positive NSCLC. 43 , 44 This aligns with our study findings of 3.78 and 5.3 LYs and 2.21 and 3.34 QALYs for patients treated with crizotinib and ceritinib, respectively. Furthermore, for patients with ROS1 -positive NSCLC, a study reported 3.35 and 2.4 LYs and 2.5 and 1.77 QALYs for crizotinib and chemotherapy treatment arms, respectively, 45 which is in line with our estimates of 4.5 and 2.01 LYs and 2.73 and 1.16 QALYs, respectively.…”

A comprehensive clinical evaluation of first-line drugs for ALK-positive advanced non-small cell lung cancer

“…The results showed that for first-line drug treatment of ALK-positive advanced NSCLC patients, second-generation ALK-TKIs (ceritinib, alectinib, and ensartinib) have a cost-utility advantage over first-generation crizotinib ( 33 - 35 ). Among second-generation ALK-TKI drugs, the cost-utility value of ceritinib was superior to that of alectinib ( 35 ).…”

“…As antitumor drugs, it is vitally important to comprehensively evaluate the clinical value of ALK-TKIs, which have high clinical demand and good targeted therapeutic effects in treating ALK-positive advanced NSCLC. Previous studies have mainly considered the clinical value of ALK-TKIs based on one or two dimensions, such as safety, efficacy ( 40 ), or economy ( 33 , 34 ). In addition, the study subjects included patients treated with ALK-TKIs in both first-line and later treatments.…”

The cost-effectiveness of iruplinalkib versus alectinib in anaplastic lymphoma kinase-positive crizotinib-resistant advanced non-small-cell lung cancer patients in China

“…First, there is no direct evidence comparing iruplinalkib with alectinib in this setting, so clinical data of alectinib were collected based on its international multicenter RCT (ALUR), of which patients were not limited to Chinese. Therefore, there may exist residual biases resulting from unobserved prognostic variables and effect modifiers ( 45 ), since the indirect comparing MAIC may be limited by the patients’ baseline information reported in the article. Second, because of the short median follow-up duration (18.2 months, 95%CI 16.8–18.8), a parametric survival model was used to extrapolate the long-term outcomes based on the immature OS curves.…”