Pcn222 Carfilzomib/Lenalidomide/Dexamethasone in the Second-Line Setting Followed by Daratumumab/Lenalidomide/Dexamethasone in the Third-Line Setting Versus the Opposite Treatment Sequence: A Cost Comparison Study From a Brazilian Private Health Care Perspective

Abstract

specialists. Direct medical costs included drug acquisition and administration, follow-up, CNS progression and end-of-life care. Costs were extracted from official sources, while health resource usage was defined by a multidisciplinary team. All costs were based on the 2019 Brazilian private healthcare system perspective (1 BRL = 0.27 USD) and a 5% discount rate was applied for costs and effectiveness. Utilities were extracted from the quality-of-life assessment at ALEX trial. Validity of the results were evaluated on sensitivity analyses. Results: Overall, alectinib improved quality-adjusted life-years gained in 0.87, with a cost decrease of 41,742 BRL (11,270 USD), thus, being dominant over crizotinib. The result was driven mostly by the reduction in CNS progression costs and PFS utility. Most of the probabilistic iterations (.90%) were located on the I and IV cost-effectiveness plane quadrants, demonstrating the model robustness and alectinib's superiority in effectiveness. Conclusions: Alectinib was dominant over crizotinib in treating naive ALK+ NSCLC patients under the Brazilian private healthcare system perspective, offering higher effectiveness and lower global treatment costs.