OBJECTIVES: Anaplastic lymphoma kinase (ALK) inhibitors, including Alectinib, Brigatinib, and Ceritinib, are recommended by the National Comprehensive Cancer Network (NCCN) for treating patients with ALK-arranged non-small-cell lung cancer (NSCLC) in an advanced stage. However, these drugs have not been listed in the National List of Essential Medicines (NLEM), and no economic evaluation studies have been conducted in Thailand. This study aimed to evaluate the cost-utility analysis of Alectinib, Brigatinib, and Ceritinib compared to standard chemotherapy in advanced NSCLC patients.

METHODS: A Markov model was developed to project the economic and health outcomes for treating advanced NSCLC patients from a societal perspective. The time horizon was the lifetime of the patients. The outcome was quality-adjusted life years (QALYs). The cost parameters were derived from a literature review and the standard cost list of the Thai Health Technology Assessment (HTA). The transitional probability parameters were extracted from a literature review of international journals. The incremental cost-effectiveness ratio (ICER) was performed to demonstrate the cost-effectiveness of alternative regimens. We conducted one-way and probabilistic sensitivity analyses.

RESULTS: The ranking of incremental cost-effectiveness ratios from lowest to highest were Ceritinib 450 mg/day (26,380 US Dollar (USD)/QALY) followed by Ceritinib 750 mg/day (44,145 USD/QALY), Alectinib 600 mg/day (66,948 USD/QALY) Brigatinib 180 mg/day (84,030 USD/QALY) and Alectinib 1,200 mg/day (133,565 USD/QALY). However, all ALK inhibitors were not cost-effective at the willingness to pay (WTP) in Thailand. Utilities were the parameters with the greatest impact on ICER fluctuation.

CONCLUSIONS: All ALK inhibitors were not cost-effective for treating ALK-arranged NSCLC patients in Thailand. Of these, Ceritinib 450 mg/day was the most likely to be cost-effective. These results could be used as evidence to support policymakers for reimbursement decision and finding alternative funding solution.