OBJECTIVES: Loco-regional or metastatic disease recurrence remains common in patients with early non-small cell lung cancer (NSCLC) despite curative-intent therapy. ALK-positive NSCLC patients are at a particularly high risk of developing brain metastases associated with poorer overall survival, a high treatment burden, poorer quality of life, and significant economic burden.

METHODS: Using an epidemiological model, we estimated the reduction in loco-regional and metastatic recurrences following treatment with adjuvant alectinib in resected ALK+ stage IB-IIIA NSCLC patients over a 10-year period (2025-2034), relative to best supportive care (BSC), defined as adjuvant platinum-based chemotherapy. We used data from CANSIM, the literature and market research to obtain data on incidence, stage distribution, biomarker prevalence, and adjuvant treatment rates. Evidence on disease-free survival of patients treated with adjuvant alectinib was obtained from the ALINA (NCT03456076) trial. Reductions in treatment costs were estimated as the per patient cost of treating recurrent and metastatic NSCLC, using clinical evidence and expert opinion on the treatments that patients would receive after experiencing recurrence.

RESULTS: Between 2025-2034, a total of 778 patients were projected to be eligible for treatment with adjuvant alectinib across Canada, out of which 521 were estimated to develop loco-regional or metastatic disease recurrence if treated with BSC. In the base case, where adjuvant alectinib was introduced and administered in 75% of eligible patients, a total of 239 recurrences (54% reduction) could be averted. The highest absolute reduction in recurrences was estimated in Quebec (N=91), followed by Ontario (65) and British Columbia (30). Adjuvant alectinib was estimated to reduce CAD$ 57M in recurrence treatment costs across Canada over 10 years.

CONCLUSIONS: Treatment with adjuvant alectinib may result in a considerable population-level reduction of recurrences in resected stage IB-IIIA ALK+ NSCLC patients across Canada. This translates to a substantial decrease in the economic burden of the disease.