Model-Based Economic Evaluation of Ceritinib and Platinum-Based Chemotherapy as First-Line Treatments for Advanced Non-Small Cell Lung Cancer in China
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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.
KeywordsAnaplastic lymphoma kinase Ceritinib Cost-effectiveness Markov model NSCLC
This work and associated journal article processing charges were supported by the National Natural Science Foundation of China (grant numbers 81401547, 81603081); and the Key Science-Technology Research and Development Program of Hunan Province (grant number 2016JC2062). All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Ye Peng, Fang Ma, Chongqing Tan, Xiaomin Wan, Lidan Yi, Liubao Peng and Xiaohui Zeng have nothing to disclose.
Compliance with Ethics Guidelines
Because our economic evaluation was based on a mathematical model to simulate the patient’s lifetime, it did not require the approval of the independent ethics committee. This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
- 1.Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Allen C, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol. 2017;3(4):524–48.CrossRefGoogle Scholar
- 2.Zaidi Z, Hamdi Cherif M. PS01.07: Geographical distribution of lung cancer mortality worldwide: topic: pathology. J Thorac Oncol. 2016;11(11S):S273–4.Google Scholar
- 7.Nation Comprehensive Cancer Network. Non-small cell lung cancer [version 2.2019]. https://www.nccn.org/. Accessed 13 Aug 2019.
- 15.China Center for Health Economic Research. China guidelines for pharmacoeconomic evaluations (Version 2011) [in Chinese] (2011). https://tools.ispor.org/peguidelines/. Accessed 13 Aug 2019.
- 16.The People’s Bank of China. Exchange rate. http://www.pbc.gov.cn. Accessed 13 Aug 2019.
- 17.Cho BC, Kim DW, Bearz A, 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.CrossRefGoogle Scholar
- 18.Cho BC, Obermannova R, Bearz A, et al. Efficacy and safety of ceritinib (450 mg/d or 600 mg/d) with food versus 750-mg/d fasted in patients with ALK receptor tyrosine kinase (ALK)-positive NSCLC: primary efficacy results from the ASCEND-8 study. J Thorac Oncol. 2019;14:1255–65.CrossRefGoogle Scholar
- 19.Novartis Pharmaceuticals Corporation. Zykadia dosing and administration. https://www.hcp.novartis.com/products/zykadia/alk-nsclc/dosing-administration. Accessed 13 Aug 2019.
- 20.European Medical Agency. Zykadia European public assessment report. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/003819/WC500187504.pdf. Accessed 13 Aug 2019.
- 22.Zeng X, Peng L, Li J, et al. Cost-effectiveness of continuation maintenance pemetrexed after cisplatin and pemetrexed chemotherapy for advanced nonsquamous non-small-cell lung cancer: estimates from the perspective of the Chinese health care system. Clin Ther. 2013;35(1):54–65.CrossRefGoogle Scholar
- 25.Chongqing T, Liubao P, Xiaohui Z, et al. Cost-utility analysis of the newly recommended adjuvant chemotherapy for resectable gastric cancer patients in the 2011 Chinese National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology: Gastric Cancer. Pharmacoeconomics. 2014;32(3):235–43.CrossRefGoogle Scholar
- 36.National Bureau of Statistics of China. China statistical year book 2018. http://www.stats.gov.cn/tjsj/ndsj/2018/indexeh.htm. Accessed 13 Aug 2019.
- 38.Gao SN, Liu GQ. The application of pharmacoeconomics in the field of medicine and health [in Chinese]. Drug Econ. 2017;12(8):16–8.Google Scholar
- 40.Announcement of the “2019 National Medical Insurance Drug Catalogue Adjustment Work Plan”. China Health Insurance. https://www.zgylbx.com/. Accessed 13 Aug 2019.