OBJECTIVES: Lung cancer is the leading cause of cancer mortality worldwide[1]. Advances in targeted treatment have brought unprecedented efficacy outcomes in NSCLC. The analysis evaluates the cost-effectiveness of adjuvant alectinib in Italy compared to platinum-based adjuvant chemotherapy for patients with anaplastic lymphoma kinase (ALK)-positive Non-Small Cell Lung Cancer (NSCLC) in completely resected stage Ib (tumors ≥ 4 cm) to stage IIIA.

METHODS: The analysis was conducted from the Italian National Health Service (NHS) perspective using a semi-Markov cohort model and a lifetime time horizon (40 years). Clinical inputs were derived from the ALINA study. The outcomes considered were life-years (LYs) and quality-adjusted life-years (QALYs), while results were expressed in terms of incremental cost-effectiveness ratio (ICER). Costs included were related to treatment, healthcare resource use, adverse events and terminal care. Costs and outcomes were discounted at 3%. Finally, deterministic and probabilistic sensitivity analyses were conducted to test the impact of parameters on the base case results.

RESULTS: Adjuvant alectinib for ALK-positive NSCLC patients is the most expensive treatment compared to the chemotherapy arm, which is the current standard of care. The higher cost, amounting to €26,864.41, is mainly due to treatment expenses. However, alectinib is also the most effective, providing an increase of 5.05 LYs and 3.11 QALYs. Additionally, it is expected to reduce adverse events, healthcare resource use, and terminal care costs. The resulting ICER is €8,644.83 per QALY.

CONCLUSIONS: Alectinib represents a cost-effective therapeutic option for the NHS compared to chemotherapy, providing significant gains in LYs and QALYs despite higher costs.

[1] Araghi M, Mannani R, Heidarnejad Maleki A, Hamidi A, Rostami S, Safa SH, Faramarzi F, Khorasani S, Alimohammadi M, Tahmasebi S, Akhavan-Sigari R. Recent advances in non-small cell lung cancer targeted therapy; an update review. Cancer Cell Int. 2023 Aug 11;23(1):162. doi: 10.1186/s12935-023-02990-y. PMID: 37568193; PMCID: PMC10416536.