Cost-Effectiveness Analyses of Repotrectinib in TKI-Naïve Patients with ROS1+ Advanced Non-Small Cell Lung Cancer
Author(s)
Stephen Chaplin, BSc1, Ken O'Day, PhD, MPA2, Adam Lee, MSc3, Ben Feakins, DPhil4, Qianyi Li, MS2, Erika Wissinger, PhD2, Kellie Meyer, PharmD, MPH2, Yong Yuan, PhD, MPH, MA5;
1Cencora, Woking, United Kingdom, 2Cencora, Conshohocken, PA, USA, 3BMS, Uxbridge, United Kingdom, 4Cencora, Dublin, Ireland, 5BMS, Lawrenceville, NJ, USA
1Cencora, Woking, United Kingdom, 2Cencora, Conshohocken, PA, USA, 3BMS, Uxbridge, United Kingdom, 4Cencora, Dublin, Ireland, 5BMS, Lawrenceville, NJ, USA
Presentation Documents
OBJECTIVES: ROS1 fusions (ROS1+, present in 1-2% of all NSCLC) are associated with responsiveness to certain tyrosine kinase inhibitors (TKIs). Repotrectinib is a next-generation ROS1+ TKI with demonstrated durable efficacy and safety in TRIDENT-1, a phase I/II single-arm trial. This study aims to evaluate the cost-effectiveness of repotrectinib versus SoC in TKI-naïve patients with ROS1+ advanced NSCLC.
METHODS: The model takes a hypothetical UK NHS perspective and estimates outcomes/costs of repotrectinib versus entrectinib over a 30-year time horizon at a 3.5% annual discount rate. Model structure features a partitioned survival approach comprising 3 health states (pre-progression, post-progression, and dead). Repotrectinib PFS was estimated by parametric fitting of the individual patient data from TRIDENT-1. Hazard ratio for comparator PFS was obtained from a matching-adjusted indirect treatment comparison using respective trials. Given the immaturity of OS data, PFS was used as a surrogate to estimate OS based on a US Flatiron analysis. Dosing regimens and time on treatment followed the clinical trials, with assumed acquisition cost parity between the treatments. Drug administration, monitoring, adverse events, subsequent therapies, and end-of-life costs were obtained from the NHS, NICE, and other literature-based sources. EQ-5D utility weights were mapped from EOTRC data in TRIDENT-1.
RESULTS: Patients on repotrectinib achieved better outcomes (4.90 QALYs and 6.00 LYs) than those on entrectinib (2.81 QALYs and 3.45 LYs). Using parity price, total costs for repotrectinib and entrectinib were £183,629 and £143,680, respectively, with an incremental cost-effectiveness ratio (ICER) of £19,134/QALY. A scenario analysis with a 20% premium price over entrectinib resulted in an ICER at the upper limit of NICE's cost-effectiveness threshold. Scenario analyses were also performed using alternative comparators, different assumptions for estimating survival, and treatment duration.
CONCLUSIONS: Repotrectinib is a cost-effective option for TKI-naïve patients with ROS1+ advanced NSCLC. These findings were robust across a variety of scenarios and sensitivity analyses.
METHODS: The model takes a hypothetical UK NHS perspective and estimates outcomes/costs of repotrectinib versus entrectinib over a 30-year time horizon at a 3.5% annual discount rate. Model structure features a partitioned survival approach comprising 3 health states (pre-progression, post-progression, and dead). Repotrectinib PFS was estimated by parametric fitting of the individual patient data from TRIDENT-1. Hazard ratio for comparator PFS was obtained from a matching-adjusted indirect treatment comparison using respective trials. Given the immaturity of OS data, PFS was used as a surrogate to estimate OS based on a US Flatiron analysis. Dosing regimens and time on treatment followed the clinical trials, with assumed acquisition cost parity between the treatments. Drug administration, monitoring, adverse events, subsequent therapies, and end-of-life costs were obtained from the NHS, NICE, and other literature-based sources. EQ-5D utility weights were mapped from EOTRC data in TRIDENT-1.
RESULTS: Patients on repotrectinib achieved better outcomes (4.90 QALYs and 6.00 LYs) than those on entrectinib (2.81 QALYs and 3.45 LYs). Using parity price, total costs for repotrectinib and entrectinib were £183,629 and £143,680, respectively, with an incremental cost-effectiveness ratio (ICER) of £19,134/QALY. A scenario analysis with a 20% premium price over entrectinib resulted in an ICER at the upper limit of NICE's cost-effectiveness threshold. Scenario analyses were also performed using alternative comparators, different assumptions for estimating survival, and treatment duration.
CONCLUSIONS: Repotrectinib is a cost-effective option for TKI-naïve patients with ROS1+ advanced NSCLC. These findings were robust across a variety of scenarios and sensitivity analyses.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE453
Topic
Economic Evaluation
Disease
SDC: Oncology, STA: Personalized & Precision Medicine