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Cost Effectiveness of Ceritinib and Alectinib Versus Crizotinib in First-Line Anaplastic Lymphoma Kinase-Positive Advanced Non-small-cell Lung Cancer

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Abstract

Background

Crizotinib, ceritinib, and alectinib improved survival in patients with anaplastic lymphoma kinase (ALK) arrangement non-small-cell lung cancer (NSCLC); however, the long-term economic outcomes of using ceritinib and alectinib versus crizotinib are still unclear.

Objective

This analysis aimed to evaluate the cost effectiveness of ceritinib and alectinib versus crizotinib in the Chinese healthcare setting.

Methods

A Markov model was developed to project the economic and health outcomes for the treatment of advanced NSCLC with ceritinib, alectinib or crizotinib. A network meta-analysis was performed to calculate the hazard ratios of ceritinib and alectinib versus crizotinib by pooling published trials. Cost and utility values were obtained from the literature, and one-way and probabilistic sensitivity analyses were carried out to determine the robustness of the model outcomes. The primary outputs included total cost, life-years (LYs), quality-adjusted LYs (QALYs), and incremental cost-effectiveness ratio (ICER).

Results

Treatment with alectinib and ceritinib yielded an additional 1.00 and 1.09 QALYs and incremental costs of $62,232 and $15,165, resulting in an ICER of $62,231 and $13,905 per QALY compared with crizotinib, respectively. Parameters related to drug costs and progression-free survival were the main drivers of the model outcomes. From the probabilistic sensitivity analysis, ceritinib and alectinib had a 99.9% and 0% probability of being cost effective, respectively, at a willingness-to-pay threshold of US$28,410/QALY.

Conclusions

Our results indicate that compared with crizotinib and alectinib, ceritinib is a cost-effective option for treatment-naïve patients with ALK-positive advanced NSCLC.

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References

  1. GBD 2015 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1859–922.

    Article  Google Scholar 

  2. Christopoulos P, Budczies J, Kirchner M, Dietz S, Sultmann H, Thomas M, et al. Defining molecular risk in ALK(+) NSCLC. Oncotarget. 2019;10:3093–103.

    Article  Google Scholar 

  3. Khan M, Lin J, Liao G, Tian Y, Liang Y, Li R, et al. ALK inhibitors in the treatment of ALK positive NSCLC. Front Oncol. 2018;8:557.

    Article  Google Scholar 

  4. Ettinger DS, Aisner DL, Wood DE, Akerley W, Bauman J, Chang JY, et al. NCCN Guidelines insights: non-small cell lung cancer, version 5.2018. J Natl Compr Cancer Netw. 2018;16:807–21.

    Article  Google Scholar 

  5. Lyu C, Wu N. Management guidelines for primary lung cancer 2018: Chinese standards in clinical practice. Chin J Cancer Res. 2019;31:419–20.

    Article  Google Scholar 

  6. Solomon BJ, Mok T, Kim DW, Wu YL, Nakagawa K, Mekhail T, et al. First-line crizotinib versus chemotherapy in ALK-positive lung cancer. N Engl J Med. 2014;371:2167–77.

    Article  Google Scholar 

  7. Soria JC, Tan DS, Chiari R, Wu YL, Paz-Ares L, Wolf J, et al. First-line ceritinib versus platinum-based chemotherapy in advanced ALK-rearranged non-small-cell lung cancer (ASCEND-4): a randomised, open-label, phase 3 study. Lancet. 2017;389:917–29.

    Article  CAS  Google Scholar 

  8. Williams C, Lewsey JD, Mackay DF, Briggs AH. Estimation of survival probabilities for use in cost-effectiveness analyses: a comparison of a multi-state modeling survival analysis approach with partitioned survival and markov decision-analytic modeling. Med Decis Mak. 2017;37:427–39.

    Article  Google Scholar 

  9. Cho BC, Kim DW, Bearz A, Laurie SA, McKeage M, Borra G, et al. ASCEND-8: a randomized phase 1 study of ceritinib, 450 mg or 600 mg, taken with a low-fat meal versus 750 mg in fasted state in patients with anaplastic lymphoma kinase (ALK)-rearranged metastatic non-small cell lung cancer (NSCLC). J Thorac Oncol. 2017;12:1357–67.

    Article  Google Scholar 

  10. Duruisseaux M, Besse B, Cadranel J, Perol M, Mennecier B, Bigay-Game L, et al. Overall survival with crizotinib and next-generation ALK inhibitors in ALK-positive non-small-cell lung cancer (IFCT-1302 CLINALK): a French nationwide cohort retrospective study. Oncotarget. 2017;8:21903–17.

    Article  Google Scholar 

  11. Xiao J, Sun JF, Wang QQ, Qi X, Yao HY. Health economic evaluation reporting guideline and application status. Zhonghua Yu Fang Yi Xue Za Zhi. 2017;51:276–80.

    CAS  PubMed  Google Scholar 

  12. Peters S, Camidge DR, Shaw AT, Gadgeel S, Ahn JS, Kim DW, et al. Alectinib versus crizotinib in untreated ALK-positive non-small-cell lung cancer. N Engl J Med. 2017;377:829–38.

    Article  CAS  Google Scholar 

  13. Guyot P, Ades AE, Ouwens MJ, Welton NJ. Enhanced secondary analysis of survival data: reconstructing the data from published Kaplan–Meier survival curves. BMC Med Res Methodol. 2012;12:9.

    Article  Google Scholar 

  14. Thompson CJ, Hoyle M, Green C, Liu Z, Welch K, Moxham T, et al. Bevacizumab, sorafenib tosylate, sunitinib and temsirolimus for renal cell carcinoma: a systematic review and economic evaluation. Health Technol Assess. 2010;14:1–184.

    Google Scholar 

  15. Li J, Knoll S, Bocharova I, Tang W, Signorovitch J. Comparative efficacy of first-line ceritinib and crizotinib in advanced or metastatic anaplastic lymphoma kinase-positive non-small cell lung cancer: an adjusted indirect comparison with external controls. Curr Med Res Opin. 2019;35:105–11.

    Article  Google Scholar 

  16. Carlson JJ, Suh K, Orfanos P, Wong W. Cost effectiveness of alectinib vs. crizotinib in first-line anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer. Pharmacoeconomics. 2018;36:495–504.

    Article  Google Scholar 

  17. Zhou ZY, Mutebi A, Han S, Bensimon AG, Louise RM, Xie J, et al. Cost-effectiveness of ceritinib in previously untreated anaplastic lymphoma kinase-positive metastatic non-small cell lung cancer in the United States. J Med Econ. 2018;21:577–86.

    Article  Google Scholar 

  18. Chinese Drug Price of Drug Centralized Bid Procurement; 2019. https://db.yaozh.com/yaopinzhongbiao. Accessed 30 May 2019.

  19. Lu S, Zhang J, Ye M, Wang B, Wu B. Economic analysis of ALK testing and crizotinib therapy for advanced non-small-cell lung cancer. Pharmacogenomics. 2016;17:985–94.

    Article  CAS  Google Scholar 

  20. Nafees B, Lloyd AJ, Dewilde S, Rajan N, Lorenzo M. Health state utilities in non-small cell lung cancer: an international study. Asia Pac J Clin Oncol. 2017;13:e195–203.

    Article  Google Scholar 

  21. Guan H, Sheng Y, Guo W, Han S, Shi L. Cost-effectiveness of alectinib for patients with untreated ALK-positive non-small cell lung cancer in China. Adv Ther. 2019;36:1114–25.

    Article  CAS  Google Scholar 

  22. Li H, Liu GG, Wu J, Wu JH, Dong CH, Hu SL. Recent pricing negotiations on innovative medicines pilot in China: experiences, implications, and suggestions. Value Health Reg Issues. 2018;15:133–7.

    Article  Google Scholar 

  23. Dias S, Sutton AJ, Ades AE, Welton NJ. Evidence synthesis for decision making 2: a generalized linear modeling framework for pairwise and network meta-analysis of randomized controlled trials. Med Decis Mak. 2013;33:607–17.

    Article  Google Scholar 

  24. Spagnuolo A, Maione P, Gridelli C. Evolution in the treatment landscape of non-small cell lung cancer with ALK gene alterations: from the first- to third-generation of ALK inhibitors. Expert Opin Emerg Drugs. 2018;23:231–41.

    Article  CAS  Google Scholar 

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Author notes

  1. Hongchao Li and Lei Lai contributed equally to this work.

Authors and Affiliations

  1. School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China

    Hongchao Li

  2. Department of Medical Oncology, Tongxiang First People’s Hospital, Tongxiang, 314500, China

    Lei Lai

  3. Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China

    Bin Wu

Authors
  1. Hongchao Li
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  2. Lei Lai
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  3. Bin Wu
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Corresponding author

Correspondence to Bin Wu.

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Conflict of interest

Hongchao Li, Lei Lai and Bin Wu have no conflicts of interest to declare.

Funding

No funding or sponsorship was received for this work.

Author Contributions

HL, LL and BW were involved in the design of the study, collected the data and performed the economic analysis. BW wrote the first draft of the manuscript, which was critically revised by LS.

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No additional data are available.

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Li, H., Lai, L. & Wu, B. Cost Effectiveness of Ceritinib and Alectinib Versus Crizotinib in First-Line Anaplastic Lymphoma Kinase-Positive Advanced Non-small-cell Lung Cancer. Clin Drug Investig 40, 183–189 (2020). https://doi.org/10.1007/s40261-019-00880-8

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