OBJECTIVES: This study aims to estimate the cost-utility of lorlatinib, a third-generation anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitor (TKI), compared with alectinib in patients with previously untreated ALK-positive locally advanced non-small cell lung cancer (ALK+ aNSCLC) from China healthcare system perspective.

METHODS: A partition survival model with four health states including progression-free, non-central nervous system [CNS] progressed disease, CNS-progressed disease, and death was developed. A life-time horizon was used in the model. The clinical, utility and cost parameters required for the model were obtained from key clinical trials, published literature and clinical experts. An indirect treatment comparison was performed to inform the efficacy of lorlatinib vs alectinib due to a lack of head-to-head comparison. Three times the per capita gross domestic product (GDP, CNY 85,698 in 2022) is used as the willingness to pay threshold. Sensitivity analysis were performed to test the stability of the model.

RESULTS: In the base-case scenario, lorlatinib resulted in a gain of 1.38 QALYs（5.28 vs. 3.90） and an incremental cost of CNY 113,810（CNY 847,992 vs. CNY 734,182） compared with alectinib. The incremental cost per QALY gain was CNY 82,824/ QALY, which is lower than one time GDP per capita. One-way sensitivity analysis presented that the hazard ratio (HR) of overall survival (alectinib vs. crizotinib), HR of progression-free survival (alectinib vs. crizotinib) and the drug price of alectinib were the main factors that had the impact on the model outcomes. Probability sensitivity analysis showed that the outcomes were consistent.

CONCLUSIONS: At current price, lorlatinib is more cost-effective than alectinib as the first-line treatment in patients withALK+ aNSCLC.