Economic burden of brain metastases in patients with anaplastic lymphoma kinase positive (ALK+) non–small cell lung cancer (NSCLC) receiving second-line ALK inhibitors.

Abstract

13 Background: De-novo brain metastases (BM) occur in 15-35% of patients with ALK+ NSCLC, and the prevalence increases to as high as 60% over the course of first-line crizotinib therapy. Reports on the economic burden of brain metastases in patients who progress on first-line therapy are scarce. The objective of this study was to evaluate the economic impact of BM among patients with ALK+ NSCLC treated with second-line ALK inhibitors. Methods: This retrospective study used the Optum Research database to identify adult patients with a lung cancer diagnosis code (≥1 inpatient claim or ≥2 outpatient claims ≥30 days but ≤1 year apart) and use of a second-line ALK inhibitor (e.g. alectinib or ceritinib) after crizotinib, between January 2011 and March 2017. Index date was defined as the date of the first claim with a second-line ALK inhibitor. BM were identified if the patient had BM diagnosis prior to index date. Healthcare costs and resource utilization were calculated on a per-patient-per-month (PPPM) basis up to 12 months of follow up after index date. Multivariate regression was used to assess the impact of BM on PPPM cost, while controlling for patient demographics, comorbidities and type of second-line ALK inhibitor. Results: 523 patients with NSCLC received at least one ALK inhibitor during the study period. Use of a second-line ALK inhibitor (alectinib or ceritinib post-crizotinib) was observed in 112 patients (43 alectinib, 69 ceritinib). Among second-line ALK inhibitor users, 52.7% (n = 59) had BM. In those with BM, the PPPM total healthcare costs were $26,415 compared with $21,278 in those without BM. Regression results showed that the adjusted mean total PPPM cost for those receiving second-line ALK inhibitor with BM was 1.39 times as high as those without BM (p-value = 0.0287). Conclusions: Economic burden of brain metastases is high for ALK+ NSCLC patients receiving second-line ALK inhibitors. The study highlights the economic value of novel therapies to delay brain metastases during early lines of therapy in these patients.