OBJECTIVES: This study aimed to evaluate its economic value in comparison to platinum-based chemotherapy for the treatment of Anaplastic Lymphoma Kinase (ALK)-positive early-stage non–small-cell lung cancer (NSCLC) from the perspective of the Chinese health care system.

METHODS: A five-state Markov model with one-month cycle length was developed to estimate the lifetime costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) in terms of cost per LY gained and per QALY gained. Estimates of health care costs were obtained from database, expert opinions and published literature, and utilities were primarily derived from a multicenter cross-sectional study based on the Chinese population. The model estimated the effect of treatment regimens on costs and outcomes discounted at 5% per year. Sensitivity analyses and scenario analyses were conducted to assess uncertainty in model results.

RESULTS: Compared to platinum-based chemotherapy, alectinib increased total costs by $29,744 and provided gains of 2.53 LYs and 2.25 QALYs over a lifetime horizon, resulting in ICERs of $11,755/LY and $13,218/QALY. The ICER in terms of cost per QALY gained was most sensitive to the outcome discount rate and the cost of alectinib in DFS. A 5.56% reduction in alectinib’s price would make alectinib cost-effective at a willing-to pay (WTP) threshold of $12,161/QALY (1 GDP per capita). Probabilistic sensitivity analyses showed that the probability of adjuvant alectinib being cost-effective was 28% at a threshold of $12,161/QALY, and 100% at a threshold of $36,484/QALY (3 GDP per capita).

CONCLUSIONS: Alectinib was unlikely to be cost-effective in the adjuvant treatment for Chinese patients with resected ALK-positive NSCLC of stage IB, II, or IIIA at a WTP threshold of 12,161/QALY.