Abstract
The ALEX trial showed that alectinib improved progression-free survival (PFS) and delayed central nervous system (CNS) progression, when compared with crizotinib, in treating naive ALK-positive advanced non-small cell lung cancer (NSCLC) patients. The objective of this study was to evaluate the cost-effectiveness of alectinib versus crizotinib according to the Brazilian Private Healthcare System perspective. The cost-effectiveness model used a partitioned survival approach and was based on 3 mutually exclusive health states: PFS, post-progression and death. The model was populated using data from ALEX trial and Kaplan-Meier estimates were extrapolated to a lifetime horizon through parametric survival curves (OS: Weibull and log-normal; PFS: exponential and Weibull; CNS progression: exponential and log-normal; for alectinib and crizotinib, respectively). All curves were selected by statistical fit and clinical reasonability, validated by clinical specialists. Direct medical costs included drug acquisition and administration, follow-up, CNS progression and end-of-life care. Costs were extracted from official sources, while health resource usage was defined by a multidisciplinary team. All costs were based on the 2019 Brazilian private healthcare system perspective (1 BRL = 0.27 USD) and a 5% discount rate was applied for costs and effectiveness. Utilities were extracted from the quality-of-life assessment at ALEX trial. Validity of the results were evaluated on sensitivity analyses. Overall, alectinib improved quality-adjusted life-years gained in 0.87, with a cost decrease of 41,742 BRL (11,270 USD), thus, being dominant over crizotinib. The result was driven mostly by the reduction in CNS progression costs and PFS utility. Most of the probabilistic iterations (>90%) were located on the I and IV cost-effectiveness plane quadrants, demonstrating the model robustness and alectinib’s superiority in effectiveness. Alectinib was dominant over crizotinib in treating naive ALK+ NSCLC patients under the Brazilian private healthcare system perspective, offering higher effectiveness and lower global treatment costs.
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