Cost-effectiveness Of Ceritinib Research Articles

P1.14-55 Cost-Effectiveness of Ceritinib and Alectinib vs Crizotinib in First-Line Anaplastic Lymphoma Kinase-Positive Advanced NSCLC

P1.14-55 Cost-Effectiveness of Ceritinib and Alectinib vs Crizotinib in First-Line Anaplastic Lymphoma Kinase-Positive Advanced NSCLC

Model-Based Economic Evaluation of Ceritinib and Platinum-Based Chemotherapy as First-Line Treatments for Advanced Non-Small Cell Lung Cancer in China

A trial-based assessment was completed to evaluate the cost-effectiveness of ceritinib as a first-line treatment for advanced non-small cell lung cancer (NSCLC) with rearrangement of anaplastic lymphoma kinase. Based on the disease situation of advanced NSCLC, a Markov model was constructed to estimate the costs and benefits of ceritinib and platinum-based chemotherapy. The cost information and health utilities were obtained from published literature. The incremental cost-effectiveness ratio was calculated. The stability of the model was verified by sensitivity analyses. The base case analysis results indicated that compared with platinum-based chemotherapy, ceritinib therapy would increase benefits in a 5-, 10- and 15-year time horizon, with extra costs of $230,661.61, $149,321.52 and $136,414.43 per quality-adjusted life-year gained, respectively. The most sensitive parameter in the model analysis was the cost of ceritinib. Probabilistic sensitivity analysis suggested that at the current price of ceritinib, the chance of ceritinib being cost-effective was 0 at the willingness-to-pay threshold of $27,142.85 per quality-adjusted life-year (three times the per capita gross domestic product of China). As a first-line treatment for advanced NSCLC with rearrangement of anaplastic lymphoma kinase, ceritinib is unlikely to be cost-effective at the current price from the Chinese healthcare perspective. To meet the treatment demands of patients, it may be a better option to reduce the price or provide appropriate drug assistance policies.

527P - Cost-effectiveness of ceritinib in previously untreated ALK-positive advanced non-small cell lung cancer in Hong Kong

527P - Cost-effectiveness of ceritinib in previously untreated ALK-positive advanced non-small cell lung cancer in Hong Kong

PCN105 - Cost-Effectiveness of Ceritinib In Previously Untreated ALK-Positive Non-Small Cell Lung Cancer in the United Kingdom

To assess the cost-effectiveness of ceritinib versus crizotinib in the treatment of anaplastic lymphoma kinase-positive (ALK+) advanced non-small cell lung cancer (NSCLC) from the UK National Health Service (NHS) and Personal Social Service (PSS) perspective. A partitioned survival model with three health states (stable/progressive/death) was built to evaluate costs and effectiveness associated with first-line treatment with ceritinib compared to crizotinib over a 20-year time horizon. Efficacy inputs (progression-free and overall survival) of ceritinib were estimated using data from a phase III randomized trial (ASCEND-4) and were extrapolated beyond the trial period using parametric survival models. Relative efficacy of ceritinib vs. crizotinib was estimated using matching-adjusted indirect comparison based on ASCEND-4 trial data and published PROFILE 1014 results. Drug acquisition, administration, adverse event, and medical costs associated with each health state were obtained from publicly available databases or literature. Treatment-specific utilities for the pre-progression state were based on EQ-5D results from each trial. Utility for the progressive state was obtained from literature. Incremental costs per quality-adjusted life year (QALY) and life years (LY) gained were estimated comparing ceritinib vs. crizotinib. Deterministic and probabilistic sensitivity analyses were performed. Over a 20-year time horizon, total QALYs was estimated to be 3.22 for first-line treatment with ceritinib and 2.68 for first-line treatment with crizotinib. Total LYs were estimated to be 4.51 and 3.85, respectively. Total costs over the 20-year time horizon were £106,954 for ceritinib and £91,970 for crizotinib. Thus, the incremental cost per QALY gained over a 20-year time horizon was estimated to be £27,936 for ceritinib vs. crizotinib, and the corresponding incremental cost per LY gained was estimated to be £22,599. Results were robust to sensitivity analyses. Compared with crizotinib, ceritinib offers a cost-effective option in the treatment of previously untreated ALK+ advanced NCSLC.

Cost-effectiveness of ceritinib in previously untreated anaplastic lymphoma kinase-positive metastatic non-small cell lung cancer in the United States

Aims: To assess the cost-effectiveness of first-line ceritinib vs crizotinib and platinum doublet chemotherapy for anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (NSCLC) from a US third-party payer’s perspective.Materials and methods: A partitioned survival model with three health states (stable disease, progressive disease, death) was developed over a 20-year time horizon. Ceritinib’s efficacy inputs (progression-free and overall survival) were estimated from ASCEND-4; parametric survival models extrapolated data beyond the trial period. The relative efficacy of ceritinib vs chemotherapy was obtained from ASCEND-4, the relative efficacy of ceritinib vs crizotinib was estimated using a matching-adjusted indirect comparison based on ASCEND-4 and PROFILE 1014. Drug acquisition, treatment administration, adverse event management, and medical costs were obtained from publicly available databases and the literature, and inflated to 2016 US dollars. Treatment-specific stable-state utilities were derived from trials and progressive-state utility from the literature. Incremental costs per quality-adjusted life year (QALY) were estimated for ceritinib vs each comparator. Cost-effectiveness was assessed based on US willingness-to-pay thresholds. Deterministic and probabilistic sensitivity analyses were performed to test model robustness.Results: In the base case, first-line ceritinib was associated with total direct costs of $299,777 and 3.28 QALYs (from 4.61 life years gained [LYG]) over 20 years. First-line crizotinib and chemotherapy were associated with 2.73 and 2.41 QALYs, 3.92 and 3.53 LYG, and $263,172 and $228,184 total direct costs, respectively. The incremental cost per QALY gained was $66,064 for ceritinib vs crizotinib and $81,645 for ceritinib vs chemotherapy. In the first 2 years following treatment initiation, ceritinib dominated crizotinib by conferring greater health benefits at reduced total costs. Results were robust to deterministic and probabilistic sensitivity analyses.Limitations: In the absence of head-to-head trials, an indirect comparison method was used.Conclusions: Ceritinib is cost-effective compared to crizotinib and chemotherapy in the treatment of previously untreated ALK-positive metastatic NCSLC in the US.

Cost-effectiveness of ceritinib in patients previously treated with crizotinib in anaplastic lymphoma kinase positive (ALK+) non-small cell lung cancer in Canada

Background: To assess the cost-effectiveness of ceritinib vs alternatives in patients who discontinue treatment with crizotinib in anaplastic lymphoma kinase-positive (ALK+) non-small cell lung cancer (NSCLC) from a Canadian public healthcare perspective.Methods: A partitioned survival model with three health states (stable, progressive, and death) was developed. Comparators were chosen based on reported utilization from a retrospective Canadian chart study; comparators were pemetrexed, best supportive care (BSC), and historical control (HC). HC comprised of all treatment alternatives reported. Progression-free survival and overall survival for ceritinib were estimated using data reported from single-arm clinical trials (ASCEND-1 [NCT01283516] and ASCEND-2 [NCT01685060]). Survival data for comparators were obtained from published clinical trials in a NSCLC population and from a Canadian retrospective chart study. Parametric models were used to extrapolate outcomes beyond the trial period. Drug acquisition, administration, resource use, and adverse event (AE) costs were obtained from databases. Utilities for health states and disutilities for AEs based on EQ-5D were derived from literature. Incremental costs per quality-adjusted life year (QALY) gained were estimated. Univariate and probabilistic sensitivity analyses were performed.Results: Over 4 years, ceritinib was associated with 0.86 QALYs and total direct costs of $89,740 for the post-ALK population. The incremental cost-effectiveness ratio (ICER) was $149,117 comparing ceritinib vs BSC, $80,100 vs pemetrexed, and $104,436 vs HC. Additional scenarios included comparison to docetaxel with an ICER of $149,780 and using utility scores reported from PROFILE 1007, with a reported ICER ranging from $67,311 vs pemetrexed to $119,926 vs BSC. Due to limitations in clinical efficacy input, extensive sensitivity analyses were carried out whereby results remained consistent with the base-case findings.Conclusion: Based on the willingness-to-pay threshold for end-of-life cancer drugs, ceritinib may be considered as a cost-effective option compared with other alternatives in patients who have progressed or are intolerant to crizotinib in Canada.