OBJECTIVES: Lung cancer is one of the most prevalent cancers in men and women and has the highest mortality rate of all cancers except non-melanoma skin cancer. Approximately 85% of the cases are non-small cell lung cancer (NSCLC) and, among these, about 3% present the ALK+ translocation. The aim of this analysis is to compare effectiveness and incremental costs between crizotinib and standard chemotherapy in the ALK+ NSCLC treatment from the Brazilian public healthcare system perspective.

METHODS: A cost-effectiveness analysis was developed using a partitioned survival model, which followed patients with advanced ALK+ NSCLC throughout a lifetime horizon, considering the transition through different health states (progression-free survival, progression, and death). The outcomes evaluated monthly were life years gained (LY) and quality-adjusted life years gained (QALY).

RESULTS: Crizotinib provides gains in terms of LY (3.67) and QALY (1.84) when compared to standard chemotherapy, with the need for incremental costs, resulting in an ICER/LY of approximately BRL 42,000 and ICER/QALY of BRL 83,500. The ICER/QALY is only 2.4 times the Brazilian GDP per capita, which is within the recent established threshold for serious diseases (3 times Brazilian GDP per capita)

CONCLUSIONS: Considering that crizotinib provides significant gains compared to chemotherapy in the treatment of advanced ALK+ NSCLC in first line, it was incorporated into the Brazilian public healthcare system in December 2022.