OBJECTIVES: To evaluate the cost effectiveness of lorlatinib in comparison to alectinib and ceritinib, as second-line treatments for patients with ALK-positive advanced NSCLC in China.

METHODS: We employed a partitioned survival model (PSM) to forecast the economic and health outcomes associated with the treatment of ALK-positive advanced NSCLC using lorlatinib, alectinib, and ceritinib. Clinical trial data from the "Lorlatinib Trial" were extrapolated to generate progression-free survival and overall survival curves for the lorlatinib cohort. The matching-adjusted indirect comparison method was utilized to derive corresponding survival curves by determining the hazard ratios of ceritinib and alectinib in reference to lorlatinib. We calculated costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) from a healthcare system perspective using a 5% annual discount rate. Robustness checks were performed using one-way sensitivity analysis (OWSA) and a probabilistic sensitivity analysis (PSA).

RESULTS: The lorlatinib treatment cohort had incremental costs of ¥110,883.07, incremental QALYs of 1.22, and an ICER of ¥91,025.00/QALY compared to alectinib in the base case. When compared to ceritinib, the incremental costs of lorlatinib was ¥1135427.28, the incremental QALYs were 2.10, and the ICER was ¥164555.13/QALY. When using 1.5 times the 2021 GDP per capita of China (¥121,464) as the willingness-to-pay (WTP) threshold, lorlatinib was cost effective for second-line treatment of ALK-positive NSCLC compared to alectinib and ceritinib. The robustness of the baseline deterministic results was confirmed in sensitivity analyses.

CONCLUSIONS: From the perspective of the Chinese healthcare system, lorlatinib presents a cost-effective alternative to alectinib and ceritinib for the second-line treatment of advanced ALK-positive NSCLC.