OBJECTIVES: Ceritinib (Zykadia^®) is now approved for first-line (1L) treatment of ALK+ metastatic NSCLC in the US. This analysis estimated the budget impact of adding ceritinib to a US payer formulary for the 1L treatment of ALK+ metastatic NSCLC.

METHODS: Costs of treatment (drug and drug administration), drug monitoring, radiotherapy/radiosurgery, adverse events (AEs) reported in ≥5% of the patients in relevant clinical trials, progression, terminal care were estimated over 3 years under the scenarios with and without ceritinib in 1L. The analysis assumed these treatment options across the 1L to third-line (3L): alectinib, ceritinib, brigatinib, crizotinib, docetaxel, pemetrexed, platinum doublet, nivolumab, pembrolizumab, best supportive care. Ceritinib 1L was projected to reach an average market share of 6.2% (Year 1), 14.1% (Year 2), and 16.8% (Year 3) and assumed to take market share from other treatments. Model inputs were estimated based on published trials, drug labels, public data sources, and assumptions. All costs were estimated in 2016 US$ and results were tested for robustness in sensitivity analyses.

RESULTS: In a hypothetical plan with 1 million members, an estimated 26, 30, and 30 ALK+ metastatic NSCLC patients would be eligible for treatment across 1L to 3L. The estimated budget impact of adding (vs. not adding) ceritinib 1L to such US payer plan was estimated to result in plan total savings of $4,597 (Year 1), $17,601 (Year 2), $28,913 (Year 3), with per member per month (PMPM) savings ranging from 0.0004 (Year 1) to 0.0024 (Year 3), and per patient per year savings ranging from $290 (Year 1) to $1,353 (Year 3). Results were robust based on sensitivity analyses.

CONCLUSIONS: Adding ceritinib 1L treatment for ALK+ metastatic NSCLC to a US payer formulary is estimated to yield modest savings to a US payer over the first 3 years.