OBJECTIVES To assess the cost-effectiveness of ceritinib versus crizotinib in the treatment of anaplastic lymphoma kinase-positive (ALK+) advanced non-small cell lung cancer (NSCLC) from the UK National Health Service (NHS) and Personal Social Service (PSS) perspective.

METHODS A partitioned survival model with three health states (stable/progressive/death) was built to evaluate costs and effectiveness associated with first-line treatment with ceritinib compared to crizotinib over a 20-year time horizon. Efficacy inputs (progression-free and overall survival) of ceritinib were estimated using data from a phase III randomized trial (ASCEND-4) and were extrapolated beyond the trial period using parametric survival models. Relative efficacy of ceritinib vs. crizotinib was estimated using matching-adjusted indirect comparison based on ASCEND-4 trial data and published PROFILE 1014 results. Drug acquisition, administration, adverse event, and medical costs associated with each health state were obtained from publicly available databases or literature. Treatment-specific utilities for the pre-progression state were based on EQ-5D results from each trial. Utility for the progressive state was obtained from literature. Incremental costs per quality-adjusted life year (QALY) and life years (LY) gained were estimated comparing ceritinib vs. crizotinib. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS Over a 20-year time horizon, total QALYs was estimated to be 3.22 for first-line treatment with ceritinib and 2.68 for first-line treatment with crizotinib. Total LYs were estimated to be 4.51 and 3.85, respectively. Total costs over the 20-year time horizon were £106,954 for ceritinib and £91,970 for crizotinib. Thus, the incremental cost per QALY gained over a 20-year time horizon was estimated to be £27,936 for ceritinib vs. crizotinib, and the corresponding incremental cost per LY gained was estimated to be £22,599. Results were robust to sensitivity analyses.

CONCLUSIONS Compared with crizotinib, ceritinib offers a cost-effective option in the treatment of previously untreated ALK+ advanced NCSLC.