Cost-Effectiveness of Adjuvant Alectinib vs. Platinum-Based Chemotherapy in Resected Stage IB-IIIA ALK-Positive NSCLC: A French Health Economic Evaluation
Author(s)
Romain Supiot, MSc1, Alexandre Gherardi, MSc2, Léopoldine du Manoir de Juaye, PharmD2, Olfa Doghri, MSc1, Marine Sivignon, PharmD1, Michaël Duruisseaux, PhD3, Christos Chouaid, PhD4.
1Putnam Associates, HTA operations, Paris, France, 2Roche S.A.S, Health economics unit, Boulogne-Billancourt, France, 3Respiratory Department and Early Phase (EPSILYON) & Centre de Recherche en Cancérologie de Lyon (CRCL) & Université Claude Bernard Lyon 1, Lyon, France, 4Centre Hospitalier Intercommunal de Créteil (CHIC), Service de Pneumologie & Université Paris-Est Créteil (UPEC), Créteil, France.
1Putnam Associates, HTA operations, Paris, France, 2Roche S.A.S, Health economics unit, Boulogne-Billancourt, France, 3Respiratory Department and Early Phase (EPSILYON) & Centre de Recherche en Cancérologie de Lyon (CRCL) & Université Claude Bernard Lyon 1, Lyon, France, 4Centre Hospitalier Intercommunal de Créteil (CHIC), Service de Pneumologie & Université Paris-Est Créteil (UPEC), Créteil, France.
OBJECTIVES: To evaluate the cost-effectiveness of adjuvant alectinib compared to platinum-based chemotherapy in patients with completely resected stage IB to IIIA ALK-positive non-small cell lung cancer (NSCLC). The analysis was conducted from a collective perspective, in line with French health economic evaluation guidelines, incorporating local treatment patterns, healthcare resource utilization, cost data, and quality-of-life estimates, and using long-term modeling assumptions to capture clinical and economic outcomes relevant for payer decision-making in the French healthcare context.
METHODS: A cohort-level semi-Markov model was developed to simulate disease progression across eight health states (DFS, non-metastatic recurrence, metastatic recurrence (first and second-line), and death), with monthly cycles over a 40-year horizon. Clinical efficacy and safety inputs were sourced from the ALINA phase III trial. French-specific parameters (treatment patterns, healthcare resource use, and unit costs in €2024) were derived from French sources and expert input. Health utilities were based on EQ-5D-5L data from ALINA and published sources. Both costs and benefits were discounted at 2.5% annually (decreasing to 1.5% beyond year 30), following HAS recommendations. Deterministic, probabilistic (3,000 simulations), and scenario analyses were performed.
RESULTS: Adjuvant alectinib provided an incremental gain of 5.17 life-years and 4.98 QALYs compared to chemotherapy, while also reducing total costs by €56,449. This positions alectinib as a dominant strategy, offering superior effectiveness at a lower cost. Probabilistic sensitivity analysis indicated a 100% probability of alectinib being cost-effective at a €15,000/QALY willingness-to-pay threshold. Scenario and univariate sensitivity analyses confirmed the robustness of these findings, with results most influenced by variations in post-recurrence treatment distributions and assumptions regarding rechallenge practices.
CONCLUSIONS: From a collective perspective aligned with French health economic guidelines, adjuvant alectinib is a dominant and cost-effective alternative to platinum-based chemotherapy in resected stage IB-IIIA ALK-positive NSCLC, improving both survival outcomes and overall costs.
METHODS: A cohort-level semi-Markov model was developed to simulate disease progression across eight health states (DFS, non-metastatic recurrence, metastatic recurrence (first and second-line), and death), with monthly cycles over a 40-year horizon. Clinical efficacy and safety inputs were sourced from the ALINA phase III trial. French-specific parameters (treatment patterns, healthcare resource use, and unit costs in €2024) were derived from French sources and expert input. Health utilities were based on EQ-5D-5L data from ALINA and published sources. Both costs and benefits were discounted at 2.5% annually (decreasing to 1.5% beyond year 30), following HAS recommendations. Deterministic, probabilistic (3,000 simulations), and scenario analyses were performed.
RESULTS: Adjuvant alectinib provided an incremental gain of 5.17 life-years and 4.98 QALYs compared to chemotherapy, while also reducing total costs by €56,449. This positions alectinib as a dominant strategy, offering superior effectiveness at a lower cost. Probabilistic sensitivity analysis indicated a 100% probability of alectinib being cost-effective at a €15,000/QALY willingness-to-pay threshold. Scenario and univariate sensitivity analyses confirmed the robustness of these findings, with results most influenced by variations in post-recurrence treatment distributions and assumptions regarding rechallenge practices.
CONCLUSIONS: From a collective perspective aligned with French health economic guidelines, adjuvant alectinib is a dominant and cost-effective alternative to platinum-based chemotherapy in resected stage IB-IIIA ALK-positive NSCLC, improving both survival outcomes and overall costs.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE233
Topic
Clinical Outcomes, Economic Evaluation, Health Technology Assessment
Topic Subcategory
Trial-Based Economic Evaluation
Disease
Oncology