Cost-effectiveness analysis of first-line treatment with crizotinib in ROS1-rearranged advanced non-small cell lung cancer (NSCLC) in Canada

Abstract

Introduction While no direct comparative data exist for crizotinib in ROS1+ non-small cell lung cancer (NSCLC), studies have suggested clinical benefit with this targeted agent. The objective of this study was to assess the cost-effectiveness of crizotinib compared to standard platinum-doublet chemotherapy for first-line treatment of ROS1+ advanced NSCLC. Methods A Markov model was developed with a 10-year time horizon from the perspective of the Canadian publicly-funded health care system. Health states included progression-free survival (PFS), up to two further lines of therapy post-progression, palliation and death. Given a lack of comparative data and small study samples, crizotinib or chemotherapy studies with advanced ROS1+ NSCLC patients were identified and time-to-event data from digitized Kaplan-Meier curves were collected to pool PFS data. Costs of drugs, treatment administration, monitoring, adverse events and palliative care were included in 2018 Canadian dollars, with 1.5% discounting. An incremental cost-effectiveness ratio (ICER) was estimated probabilistically using 5000 simulations. Results In the base-case probabilistic analysis, crizotinib produced additional 0.885 life-years and 0.772 quality-adjusted life-years (QALYs) at an incremental cost of $238,077, producing an ICER of $273,286/QALY gained. No simulations were found to be cost-effective at a willingness-to-pay threshold of $100,000/QALY gained. A scenario analysis assuming efficacy equivalent to the ALK+ NSCLC population showed a slightly more favorable cost-effectiveness profile for crizotinib. Conclusions Available data appear to support superior activity of crizotinib compared to chemotherapy in ROS1+ advanced NSCLC. At the list price, crizotinib was not cost-effective at commonly accepted willingness-to-pay thresholds across a wide range of sensitivity analyses.

Economic Evaluation of Targeted Therapies for Anaplastic Lymphoma Kinase– and ROS1 Fusion–Positive Non–Small Cell Lung Cancer in India

“… 43 , 44 This aligns with our study findings of 3.78 and 5.3 LYs and 2.21 and 3.34 QALYs for patients treated with crizotinib and ceritinib, respectively. Furthermore, for patients with ROS1 -positive NSCLC, a study reported 3.35 and 2.4 LYs and 2.5 and 1.77 QALYs for crizotinib and chemotherapy treatment arms, respectively, 45 which is in line with our estimates of 4.5 and 2.01 LYs and 2.73 and 1.16 QALYs, respectively.…”

Cost-effectiveness analysis of adjuvant therapy with atezolizumab in Chinese patients with stage IB-IIIA resectable NSCLC after adjuvant chemotherapy

“…This study is the first to evaluate the cost-effectiveness of atezolizumab versus BSC as an adjuvant treatment strategy after postoperative platinum-based chemotherapy for early-stage NSCLC (PD-L1 TC ≥ 1% stage II – IIIA group, all stage II – IIIA groups, or the intention-to-treat group (stage IB – IIIA)) from the perspective of the Chinese health care system, Unlike studies using proportional hazards models ( 44 , 45 ), parametric curves in this study were fitted to each treatment group separately ( 46 , 47 ), and the reason for the crossover of the PFS curves may be due to the fact that atezolizumab showed a pretreatment advantage of different groups at different times. Our analysis showed that the use of atezolizumab as adjuvant therapy after platinum-based chemotherapy resulted in a higher ICER compared with the WTP threshold $(27,354/QALY) for the PD-L1 TC ≥ 1% stage II-IIIA group, all stage II-IIIA group, or the ITT group, making atezolizumab less likely to be cost-effective in patients after postoperative platinum-based chemotherapy for early NSCLC.…”