Cost-effectiveness Analysis of Lorlatinib in Patients Previously Treated with Anaplastic Lymphoma Kinase Inhibitors for Non-small Cell Lung Cancer in Greece.

George Gourzoulidis,Chrissy Lowry,Charalampos Tzanetakos,Christina Michailidi,Nadia Boubouchairopoulou,Georgia Kourlaba,Oresteia Zisimopoulou

doi:10.36469/jheor.2022.32983

George Gourzoulidis, Chrissy Lowry + Show 5 more

Open Access

https://doi.org/10.36469/jheor.2022.32983

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Abstract

Background: Non-small cell lung cancer (NSCLC), which accounts for about 80%-85% of lungcancer cases, is a leading cause of cancer-related death worldwide. Lorlatinib is a potent third-generation anaplastic lymphoma kinase (ALK) inhibitor approved for the treatment of patients with advanced, ALK-positive NSCLC previously treated with at least one second-generation ALK tyrosine kinase inhibitor.Objective: The present study assessed the cost-effectiveness of lorlatinib vs pemetrexed with platinum combination of carboplatin or cisplatin (P-ChT) in Greece.Methods: A partitioned survival model with three health states, referring to pre-progression, progressed disease, and death, was locally adapted from a Greek payer perspective over a lifetime horizon. Clinical and safety data and utility values applied in the model were extracted from the literature. A matching-adjusted indirect comparison of lorlatinib and P-ChT was performed. Only direct medical costs (€) from 2020 were included in the analysis. Primary outcomes were patient life years (LYs), quality-adjusted life years (QALYs), total costs, and incremental cost-effectiveness ratios per QALY and LY gained. All future outcomes were discounted at 3.5% per annum. A probabilistic sensitivity analysis was conducted to account for model uncertainty.Results: The analysis showed that, over a lifetime horizon, the estimated total costs of lorlatinib and P-ChT were €81 754 and €12 343, respectively. Lorlatinib was more effective than P-ChT with 2.4 and 1.5 more LYs and QALYs gained, respectively. The generated incremental cost-effectiveness ratios of lorlatinib compared with P-ChT were €28 613 per LY gained and €46 102 per QALY gained. Probabilistic sensitivity analysis confirmed the deterministic results.Conclusion: The present analysis suggests that lorlatinib may be considered as a cost-effective option compared with P-ChT in Greece for the treatment of patients with advanced, ALK-positive NSCLC whose disease has progressed after at least one second-generation ALK tyrosine kinase inhibitor. In addition, this option addresses a significant unmet medical need.

Highlights

Non-small cell lung cancer (NSCLC), which accounts for about 80%-85% of lung cancer cases, is a leading cause of cancer-related death worldwide
The generated incremental cost-effectiveness ratios of lorlatinib compared with pemetrexed plus carboplatin or cisplatin (P-ChT) were €28 613 per life year (LY) gained and €46 102 per quality-adjusted life year (QALY) gained
The present analysis suggests that lorlatinib may be considered as a cost-effective option compared with P-ChT in Greece for the treatment of patients with advanced, anaplastic lymphoma kinase (ALK)-positive NSCLC whose disease has progressed after at least one second-generation ALK tyrosine kinase inhibitor

Summary

Introduction

Non-small cell lung cancer (NSCLC), which accounts for about 80%-85% of lung cancer cases, is a leading cause of cancer-related death worldwide. Lorlatinib is a potent thirdgeneration anaplastic lymphoma kinase (ALK) inhibitor approved for the treatment of patients with advanced, ALK-positive NSCLC previously treated with at least one second-generation ALK tyrosine kinase inhibitor. Non-small cell lung cancer (NSCLC), which accounts for about 80%85% of lung cancer cases, is a leading cause of cancer-related death worldwide.[1]. Most patients with NSCLC present with advanced, incurable disease at diagnosis, expressing bothersome symptoms that affect their quality of life, such as fatigue, dyspnea, shortness of breath, and cough.[2,3]. Anaplastic lymphoma kinase (ALK)–positive NSCLC represents a small proportion (3%-5%) of patients with advanced NSCLC.[4]. Targeted therapies have substantially improved the survival outcomes of patients with ALK-positive NSCLC. The availability of multiple targeted therapeutic options for ALK-positive NSCLC has shown to be an important factor in the therapeutic management of patients with NSCLC.[5,6]. The availability of multiple targeted therapeutic options for ALK-positive NSCLC has shown to be an important factor in the therapeutic management of patients with NSCLC.[5,6] crizotinib was the first ALK inhibitor

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