OBJECTIVES

: Assess the incremental cost-effectiveness (ICER) and the cost-utility ratios (ICUR) of alectinib vs. crizotinib in patients with anaplastic lymphoma kinase-positive (ALK+) non-small cell lung cancer (NSCLC) in the Portuguese National Health System perspective.

METHODS

: A partitioned survival model, weekly-cycled, was developed considering a time horizon of 30 years. Overall Survival (OS), progression free survival (PFS) and all clinical data were obtained from the ALEX trial (Peter S. et al., 2017) and extrapolated for the time horizon considered. Utilities were measured during the trial and complemented by international literature in order to allow comparability. Population characterization and direct medical costs were based on national literature review and official public data sources respectively. Resource consumption was collected through a Portuguese expert panel. A 5% discount rate was applied to both costs and consequences. Uncertainty was tested by deterministic (DSA) and probabilistic sensitivity analysis (PSA).

RESULTS

: In comparison to crizotinib, the use of alectinib allows an increase of 0.85 life years (LY) and of 0.82 quality adjusted life-years (QALY). Considering the time horizon, it is expected an incremental cost of 18,641€ with alectinib. As a result, alectinib presents favorable ICER (21,977 €/ LY) and ICUR (22,832 €/ QALY). The probability of alectinib being cost-effective at a willingness-to-pay threshold equal to 35,000 €/QALY is over 50%. Sensitivity analysis shows that results are mainly sensitive to the extrapolation methods of PFS and treatment duration until progression.

CONCLUSIONS

: These ratios are below the thresholds that have been found acceptable for innovative targeted therapies in oncology in Portugal, confirming that alectinib is a cost-effective therapy in the first line treatment of advanced ALK+ NSCLC. DSA and PSA corroborated the conclusions obtained.