PCN129 PREVENTING BRAIN METASTASES WITH ALECTINIB IN ALK-POSITIVE NON-SMALL CELL LUNG CANCER: ECONOMIC IMPACT UNDER THE BRAZILIAN PRIVATE HEALTHCARE SYSTEM PERSPECTIVE

Abstract

Results of the ALEX trial demonstrated that alectinib decreased the risk of Central Nervous System (CNS) progression and prolonged progression-free survival of NSCLC ALK+ patients, compared with crizotinib. The objective of this study is to compare the economic burden of CNS progression with alectinib versus crizotinib, on the Brazilian private healthcare system. Cumulative incidence of CNS metastasis was extracted from ALEX Kaplan-Meier curves. A parametric approach was used to extrapolate data to a lifetime horizon. The NSCLC ALK+ population without CNS metastasis at baseline on the Brazilian private healthcare system was estimated using an epidemiologic approach. Total number of beneficiaries was extracted from the National Regulatory Agency for Private Health Insurance and Plans, lung cancer incidence was extracted from the National Cancer Institute estimative and proportions of advanced NSCLC, ALK mutation and CNS metastasis were obtained from observational studies. Resource use related to CNS metastasis progression management and follow-up was estimated by a multidisciplinary team. Direct medical costs were extracted from the Brazilian Hierarchy Classification of Medical Procedures and estimated on 2018 BRL and USD. Treatment with alectinib, compared with crizotinib, was associated with 54,937 BRL (14,086 USD) cost offsets related to CNS metastasis management, per patient, in a 5-year horizon. In a lifetime scenario, this difference increased 44%, achieving 79,321 BRL (20,339 USD). It was estimated that 166 patients with advanced NSCLC ALK+ without CNS metastasis will initiate target treatment by 2020. Total cost offsets to the Brazilian private healthcare system was estimated as 9.1 million BRL (2.3 million USD) in 5 years, and up to 12.5 million BRL (3.2 million USD) in a lifetime horizon, if alectinib was the preferred regimen. Alectinib can potentially decrease the economic burden of CNS metastasis of NSCLC ALK+ patients in the Brazilian private healthcare system, compared with the current standard of care.