OBJECTIVES : Anaplastic lymphoma kinase-positive (ALK+) non-small cell lung cancer (NSCLC) is an aggressive disease whose prognosis is changing due to the availability of second-generation ALK inhibitors. This study estimated the impact of brigatinib as monotherapy for the first-line treatment of adult patients with ALK+ advanced NSCLC on the Italian National Health System (NHS) budget.

METHODS : A dynamic budget impact model based on a partitioned survival structure considering four health states (progression-free, post-progression with and without involvement of central nervous system and death) and carry-over patients was developed from the NHS perspective. Brigatinib progressively replaced crizotinib, alectinib and ceritinib over a 3-year time horizon. Efficacy data were estimated from the ALTA-1L Phase III clinical trial and indirect treatment comparisons. The costs included were first-line and second-line drug acquisition (published list prices) and administration, disease management, adverse events and palliative care.

RESULTS : The target population was estimated at 649, 665 and 681 at year 1, 2 and 3, respectively. The introduction of brigatinib with a progressive increase of market share of 10, 20 and 27 percent, respectively, is expected to reduce overall NHS healthcare expenditure by EUR 8.1 million over 3-years.

CONCLUSIONS : The introduction of brigatinib for the treatment of first-line ALK+ NSCLC is expected to increase health benefits while decreasing costs for the Italian NHS.