OBJECTIVES: ALK-inhibitors are reimbursed in the Brazilian private healthcare system. The objective of this study was to estimate the cost-effectiveness of brigatinib versus crizotinib, the incremental costs versus alectinib and lorlatinib, and budget impact for first-line (1L) ALK+ NSCLC under the private system perspective in Brazil.

METHODS: Cost-effectiveness versus crizotinib was developed based on final analysis of ALTA-1L, with an area under the curve model with 4 health states (Pre-progression; Progression non-CNS; Progression CNS; and Death). A 20-year time horizon and 5% discount rate were applied on costs and outcomes. A prior network meta-analysis showed no significant difference between brigatinib, alectinib and lorlatinib efficacy, hence only cost comparisons were made. Health resources utilization was based on literature and expert opinion. List prices for drugs (October 2023) and Brazilian Hierarchical Classification of Medical Procedures costs were considered. A 5-year budget impact was estimated. Deterministic sensitivity analysis was conducted with +/- 20% variation for CEA and BIM.

RESULTS: Brigatinib was dominant versus crizotinib (incremental 0.78 QALY and BRL -26,388 costs) and cost-saving versus alectinib (BRL -170,737) and lorlatinib (BRL -331,297). Drug acquisition costs and subsequent treatment distribution were the main parameters to impact ICER/QALY (from dominant to BRL 107,583/QALY). With 201 front-line ALK+ NSCLC patients starting treatment per year on average, brigatinib could save BRL -13.7 million (ranging from BRL -23.7mi to -6.7mi) in 5-years to the private market.

CONCLUSIONS: Brigatinib can be a dominant treatment for 1L NSCLC ALK+ patients when compared with crizotinib and a cost-saving option when compared with alectinib and lorlatinib, with savings to the Brazilian private healthcare system. There are limitations to cost comparison against lorlatinib as no head-to-head trial is available and although NMA indicates no significant difference in efficacy, the cost comparison could need to be updated when more mature data is available for lorlatinib.