Cost-Utility Analysis of Lorlatinib in First-Line Treatment of adult patients with ALK-Positive Advanced Non-Small Cell Lung Cancer (aNSCLC) in Colombia
Author(s)
Jair A. Arciniegas, MSc1, Diego M. Gonzalez, MD2, Ricardo Bruges, MD3, Andreina J. Alamo, BSc1, Steffy Pardo, MD1, Juan Manuel Reyes Sanchez, MSc1;
1Pfizer, Bogotá, Colombia, 2Instituto de Cancerología Las Américas, Medellín, Colombia, 3Pontificia Universidad Javeriana; Instituto Nacional de Cancerología; Hospital Universitario San Ignacio, Bogotá, Colombia
1Pfizer, Bogotá, Colombia, 2Instituto de Cancerología Las Américas, Medellín, Colombia, 3Pontificia Universidad Javeriana; Instituto Nacional de Cancerología; Hospital Universitario San Ignacio, Bogotá, Colombia
Presentation Documents
OBJECTIVES: To evaluate the cost-utility of lorlatinib compared to the available ALK TKIs (alectinib, brigatinib, crizotinib) as first-line treatment option for adult patients with ALK+ aNSCLC from the Colombian healthcare system.
METHODS: A partitioned survival Markov model with four health states was developed. The defined states included: progression-free, non-central nervous system (CNS) progressed disease, CNS-progressed disease, and death. The time horizon for the model was set at 10 years with a 30-day cycle, a 5% annual discount rate, and the Colombian healthcare system perspective was adopted. Clinical, utility, and cost parameters required for the model were sourced from key clinical trials, published literature, national databases, and clinical experts. Prices were expressed in 2024 COP, and an exchange rate of 4,413.8 COP = 1USD was used. Due to the absence of head-to-head comparisons, an indirect comparison through a network meta-analysis was conducted to generate corresponding survival curves for lorlatinib against comparators. The cost-effectiveness threshold was set at three times the per-capita-gross-domestic-product, in line with national recommendations. Robustness checks were performed utilizing one-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA).
RESULTS: Lorlatinib led to the highest number of quality adjusted life years with 4.87, followed by alectinib, brigatinib and crizotinib, with 4.18, 3.72 and 2.76, respectively. In addition, lorlatinib occasioned the lowest cost ($497,653), followed by alectinib ($500,356), crizotinib ($529,949) and brigatinib ($534,388). Lorlatinib is a dominant strategy compared to the options available in the country. The OWSA indicated that lorlatinib’s price and comparators subsequent treatment costs were key parameters and the PSA showed that lorlatinib was the alternative with the highest probability of being cost-effective, with a probability of approximately 74%.
CONCLUSIONS: In the Colombian health care system setting, lorlatinib is a cost-effective alternative against alectinib, brigatinib and crizotinib for the first-line treatment of adult patients ALK-positive aNSCLC.
METHODS: A partitioned survival Markov model with four health states was developed. The defined states included: progression-free, non-central nervous system (CNS) progressed disease, CNS-progressed disease, and death. The time horizon for the model was set at 10 years with a 30-day cycle, a 5% annual discount rate, and the Colombian healthcare system perspective was adopted. Clinical, utility, and cost parameters required for the model were sourced from key clinical trials, published literature, national databases, and clinical experts. Prices were expressed in 2024 COP, and an exchange rate of 4,413.8 COP = 1USD was used. Due to the absence of head-to-head comparisons, an indirect comparison through a network meta-analysis was conducted to generate corresponding survival curves for lorlatinib against comparators. The cost-effectiveness threshold was set at three times the per-capita-gross-domestic-product, in line with national recommendations. Robustness checks were performed utilizing one-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA).
RESULTS: Lorlatinib led to the highest number of quality adjusted life years with 4.87, followed by alectinib, brigatinib and crizotinib, with 4.18, 3.72 and 2.76, respectively. In addition, lorlatinib occasioned the lowest cost ($497,653), followed by alectinib ($500,356), crizotinib ($529,949) and brigatinib ($534,388). Lorlatinib is a dominant strategy compared to the options available in the country. The OWSA indicated that lorlatinib’s price and comparators subsequent treatment costs were key parameters and the PSA showed that lorlatinib was the alternative with the highest probability of being cost-effective, with a probability of approximately 74%.
CONCLUSIONS: In the Colombian health care system setting, lorlatinib is a cost-effective alternative against alectinib, brigatinib and crizotinib for the first-line treatment of adult patients ALK-positive aNSCLC.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE256
Topic
Economic Evaluation
Disease
SDC: Oncology, STA: Personalized & Precision Medicine