Trends in ALK inhibitors for non-small cell lung cancer.

Abstract

e14046 Background: Rearrangements in the gene encoding anaplastic lymphocyte kinase (ALK) are found in 3%–5% of patients. Treatment options have significantly expanded with ALK inhibitor drug approvals including crizotinib in 2011, ceritinib in 2014, alectinib in 2015, brigatinib in 2017 and lorlatinib in 2018. We sought to better understand the real-world treatment utilization and cost of ALK inhibitors in lung cancer (LCA) over the most recent period for which adjudicated claims are available, October 2017-September 2018. Methods: A LCA disease model was built in IBM Access and Value Connect to interrogate patient demographics, payer types, clinical characteristics, clinical outcomes, utilization, costs, and treatment sequencing, informed by United States Food and Drug Administration (FDA) labels for approvals, professional society guidelines, clinical and economic literature review, and subject matter expertise. Patients were selected from IBM Marketscan Commercial and Medicare Claims database and have an approved LCA treatment, at least one diagnosis claim for LCA within 30 days of treatment, and a minimum treatment period of 90 days, but do not have claims for other cancers or pregnancy during the study period. Using advanced visual analytics, we identified trends in the cost, utilization, and clinical outcomes of LCA patients. Results: There were 2,300 LCA treated patients in our 12-month cohort from October 2017-September 2018, of which 6% were treated with an ALK inhibitor. Of those 145 patients, 59% were treated with alectinib and 33% with crizotinib. Overall all cause per-member per-month costs for alectinib and crizotinib patients were $18,541 and $19,078, respectively. While the overall costs for alectinib and crizotinib were roughly the same, ER and in-patient costs were higher for crizotinib at $1,635 and $404, respectively, compared to $503 and $57 for alectinib. Conclusions: Our analyses demonstrate alectinib is the preferred first-line ALK inhibitor in the last twelve months of available data. Furthermore, the increased ER and in-patient costs may substantiate the findings of the ALEX trial, notably higher liver toxicity and more nausea, vomiting, and diarrhea for crizotinib. There is not yet sufficient data on the newer ALK inhibitors, brigatinib and lorlatinib in the real-world.