OBJECTIVES : This study aimed to evaluate the long-term economic benefits of Alectinib versus Crizotinib in first-line treatment for anaplastic lymphoma kinase-positive (ALK+) advanced non-small cell lung cancer (NSCLC) from a China societal perspective.

METHODS : A Markov model was developed using partition survival methods and three health states: progression-free survival (PFS), post-progression survival (PPS), and death. Survival data were derived from ALEX trial, and parametric survival functions were selected for extrapolation based on the goodness of fit and clinical key opinion leaders (KOL) interview. Cost inputs for drugs (considering patient assistance programs), adverse events management, supportive care, and productivity loss were estimated from literature, public available price references, and KOL interview. Utility values were obtained from trial data and literature. Univariate and probabilistic sensitivity analyses were performed.

RESULTS : In a 30-year lifetime horizon, Alectinib was associated with 2.96QALYs, while Crizotinib was associated with 2.08QALYs. In comparison with Crizotinib, Alectinib had better health outcome (+0.88QALY) and marginal cost increase, yielding an ICER of 169,848CNY/QALY which is lower than the willingness-to-pay threshold of triple GDP per capita in China in 2017 (178,980CNY). Cost during PPS were considerably lower with Alectinib (-57%). Since central nervous system (CNS) metastasis incurred additional costs on treatments and productivity loss, CNS-related costs were also lower with Alectinib (-26%), saving 20% direct costs and 27% indirect costs. The CNS-related costs saving with Alectinib were even larger when taking a 24-months horizon (-39% direct costs and -46% indirect costs). Drug costs and PFS state utility were the main drivers.

CONCLUSIONS : Alectinib significantly improved PFS and provided considerable incremental QALYs. Meanwhile, this drug also saved PPS and CNS-related costs, with its marginal cost increase being reflective of longer treatment duration in the PFS state. From a China societal perspective, Alectinib may be considered as a cost-effective therapy for the first-line treatment of ALK+ NSCLC patients.