Cost-Effectiveness Analysis of Entrectinib in First-Line Treatment for NTRK Locally Advanced or Metastatic NSCLC in China
Author(s)
Haotian He, MBA1, Shun Lu, MD2, Mariana Al-Adwan, MSc, PharmD3, Yan XIA, MSc1, Yu Lin, PhD1.
1Shanghai Roche Pharmaceuticals Ltd., Shanghai, China, 2Department of Medical Oncology, Shanghai Chest Hospital, Shanghai, China, 3Roche, Amman, Jordan.
1Shanghai Roche Pharmaceuticals Ltd., Shanghai, China, 2Department of Medical Oncology, Shanghai Chest Hospital, Shanghai, China, 3Roche, Amman, Jordan.
OBJECTIVES: NTRK gene fusion has been identified as an oncogenic driver of various solid tumors, with a prevalence of less than 1% in NSCLC. Entrectinib, a potent NTRK inhibitor, has demonstrated efficacy in NTRK+ locally advanced or metastatic NSCLC. This study aims to evaluate the cost-effectiveness of entrectinib in comparison with larotrectinib from a Chinese payer perspective.
METHODS: This study included 54 patients with locally advanced or metastatic NTRK fusion-positive NSCLC from three clinical trials of entrectinib (ALKA-372-001, STARTRK-1, STARTRK-2), while 32 patients in the larotrectinib group. Due to the lack of head-to-head studies, a matching-adjusted indirect comparison (MAIC) was conducted previously , while the two groups were matched by demographic characteristics reported by larotrectinib to ensure that baseline characteristics were as similar as possible between the two groups. A partitioned survival model was used adapted to China's clinical practice. Health state transitions were derived from progression-free survival (PFS) and overall survival (OS) curves, extrapolated using KM curves with Exponential tail distributions from the trial data, with AIC/BIC the lowest among different distributions. Health utilities for PFS were converted from clinical trial results and mapped by Chinese tariffs, while post-progression state utilities were sourced from literature. Cost of medications 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 30 years with 4.5% discount rates, entrectinib generated an additional 0.49 QALYs with costs saving compared to larotrectinib. The ICER was -CNY73,990 (USD10,310) per QALY obtained, which means entrectinib is dominant to larotrectinib. Univariate sensitivity analysis showed that cost during PFS stage and progression stage of both groups had the greatest impact on the results.
CONCLUSIONS: Entrectinib is more cost-effective than Larotrectinib in the NTRK+ NSCLC population under Chinese clinical practice.
METHODS: This study included 54 patients with locally advanced or metastatic NTRK fusion-positive NSCLC from three clinical trials of entrectinib (ALKA-372-001, STARTRK-1, STARTRK-2), while 32 patients in the larotrectinib group. Due to the lack of head-to-head studies, a matching-adjusted indirect comparison (MAIC) was conducted previously , while the two groups were matched by demographic characteristics reported by larotrectinib to ensure that baseline characteristics were as similar as possible between the two groups. A partitioned survival model was used adapted to China's clinical practice. Health state transitions were derived from progression-free survival (PFS) and overall survival (OS) curves, extrapolated using KM curves with Exponential tail distributions from the trial data, with AIC/BIC the lowest among different distributions. Health utilities for PFS were converted from clinical trial results and mapped by Chinese tariffs, while post-progression state utilities were sourced from literature. Cost of medications 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 30 years with 4.5% discount rates, entrectinib generated an additional 0.49 QALYs with costs saving compared to larotrectinib. The ICER was -CNY73,990 (USD10,310) per QALY obtained, which means entrectinib is dominant to larotrectinib. Univariate sensitivity analysis showed that cost during PFS stage and progression stage of both groups had the greatest impact on the results.
CONCLUSIONS: Entrectinib is more cost-effective than Larotrectinib in the NTRK+ NSCLC population under Chinese clinical practice.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE197
Topic
Economic Evaluation
Disease
Oncology, Rare & Orphan Diseases