Cost-Utility Analysis of Entrectinib in the First-Line Treatment of NTRK+ Locally Advanced or Metastatic Solid Tumors in China

OBJECTIVES: Entrectinib is a potent and CNS-active TRK inhibitor for NTRK+ solid tumors. This study aimed to measure the cost-effectiveness of entrectinib versus standard of care (SoC) in the Chinese setting.

METHODS: This study included 150 patients with more than 17 different NTRK+ solid tumors from three clinical trials of entrectinib. A partitioned survival model was used to adapt to China's clinical practice. Proportion of patients within each health state was based on the progression-free survival (PFS) and overall survival (OS) curves, estimated by parametric regression on empirical data from the pooled entrectinib trials. Since the absence of head-to-head studies, mean values of PFS and OS were used for SoC, based on values from literatures with exponential functions. To ensure comparability, mean PFS and OS for each tumor type were weighted by the frequencies observed in the pooled entrectinib NTRK+ subgroups. Utility for PFS was converted from clinical trial results, mapped by Chinese tariffs, whereas literature data were used for post-progression state. Cost of drugs was calculated using Chinese local prices, while costs of drug administration and adverse effects were estimated from clinician survey. Univariate sensitivity and scenario analyses were performed to identify uncertainty.

RESULTS: Over a timeframe of 20 years with 5% discount rates, entrectinib generated an additional 1.47 QALYs with CNY84,812 (USD11,703) of additional costs compared to SoC. The ICER was CNY57,720 (USD7,965) per QALY obtained, equivalent to 0.65 times of GDP per capita in 2023. Univariate sensitivity analysis showed that discount rate, weekly cost after progression of entrectinib and time horizon had the greatest impact on the results. According to the probability sensitivity analysis, entrectinib has a 100% probability of being more cost-effective than SoC.

CONCLUSIONS: Entrectinib can improve patient health outcomes and is more cost-effective than SoC in the NTRK+ solid tumors population under Chinese clinical practice.