Cost-effectiveness analysis of ceritinib vs. crizotinib in previously untreated anaplastic lymphoma kinase (ALK)-positive non-small cell lung cancer (NSCLC) in Hong Kong

Herbert H Loong,Linda K S Leung,Zheng-Yi Zhou,Carlos K H Wong,Catherine P K Chan,Meaghan Gibbs,Jipan Xie,Andrea Chang

doi:10.1186/s12962-020-00244-6

Abstract

IntroductionLower-dose ceritinib (450 mg) once-daily with food was approved in 2018 in Hong Kong (HK) for first-line treatment of patients with anaplastic lymphoma kinase-positive (ALK +) advanced non-small cell lung cancer (NSCLC). This study examined the cost-effectiveness of ceritinib vs. crizotinib in the first-line treatment of ALK + NSCLC from a HK healthcare service provider's or government's perspective.MethodsCosts and effectiveness of first-line ceritinib vs. crizotinib over a 20-year time horizon was evaluated using a partitioned survival model with three health states (stable disease, progressed disease, and death). The efficacy data for ceritinib were obtained from a phase 3 trial comparing ceritinib with chemotherapy for advanced non-small cell lung cancer (ASCEND-4) and extrapolated using parametric survival models. Long-term survival associated with crizotinib were estimated using hazard ratio of crizotinib vs. ceritinib obtained from matching-adjusted indirect comparison based on ASCEND-4 and PROFILE 1014 trials. Drug acquisition, administration, adverse events costs, and medical costs associated with each health state were obtained from public sources and converted to 2018 US Dollars. Incremental costs per quality-adjusted-life-year (QALY) and life-year (LY) gained were estimated for ceritinib vs. crizotinib.ResultsThe base case results showed that ceritinib was associated with 3.22 QALYs, 4.51 LYs, and total costs of $157,581 over 20 years. Patients receiving crizotinib had 2.68 QALYs, 3.85 LYs, and $150,424 total costs over the same time horizon. The incremental cost per QALY gained for ceritinib vs crizotinib was $13,343. Results were robust to deterministic sensitivity analyses in most scenarios.ConclusionCeritinib offers a cost-effective option compared to crizotinib for previously untreated ALK + advanced NCSLC in HK.

Highlights

Lower-dose ceritinib (450 mg) once-daily with food was approved in 2018 in Hong Kong (HK) for first-line treatment of patients with anaplastic lymphoma kinase-positive (ALK +) advanced non-small cell lung cancer (NSCLC)
The incremental cost/quality-adjusted life years (QALYs) gained for ceritinib as a first-line treatment for Anaplastic lymphoma kinase (ALK) + NSCLC over a 20-year time horizon was estimated to be $13,343 US Dollars (USD)/QALY compared with crizotinib
Sensitivity analyses The deterministic sensitivity analysis (DSA) results showed that the incremental cost-effectiveness ratio (ICER) for ceritinib vs. crizotinib was robust in most scenarios

Summary

Introduction

Lower-dose ceritinib (450 mg) once-daily with food was approved in 2018 in Hong Kong (HK) for first-line treatment of patients with anaplastic lymphoma kinase-positive (ALK +) advanced non-small cell lung cancer (NSCLC). The response to crizotinib varies and some patients, those with brain metastases, are less likely to benefit as crizotinib may insufficiently cross the blood–brain barrier, leaving metastases in the brain inadequately treated [2]. This is a key limitation of crizotinib as the control of brain metastases is an important therapeutic goal given that the central nervous system is a common site of disease in advanced NSCLC. Patients with an initial response to crizotinib develop resistance to crizotinib within 1–2 years [3, 4]

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Results

Discussion

Conclusion