Cost-Effectiveness Analysis of Adjuvant Alectinib versus Platinum-Based Chemotherapy in Resected ALK-Positive Non-Small-Cell Lung Cancer in the Chinese Health Care System.

Abstract

Objectives: The ALINE trial demonstrated the superiority of alectinib over platinum-based chemotherapy in resected Anaplastic Lymphoma Kinase (ALK)-positive non-small-cell lung cancer (NSCLC). Considering the high cost of alectinib, this study aimed to evaluate the economic value of alectinib compared to platinum-based chemotherapy for treating early-stage ALK-positive NSCLC from the perspective of the Chinese health care system.

Materials and methods: We developed a five-state Markov model with monthly cycles to estimate the lifetime costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) in terms of cost per LY gained and per QALY gained. Costs were obtained from database, expert opinions and published literature, and utilities were primarily derived from a multicenter cross-sectional study based on the Chinese population. Costs and outcomes were discounted at 5% per year. Sensitivity analyses and scenario analyses were conducted to assess uncertainty in model results.

Results: Compared to platinum-based chemotherapy, alectinib increased total costs by $16,245 and provided gains of 2.02 LYs and 1.84 QALYs over a lifetime horizon. ICERs were $8,052/LY and $8,806/QALY. The ICER in terms of cost per QALY gained was most sensitive to the outcome discount rate. Probabilistic sensitivity analysis indicated a 93% probability of alectinib being cost-effective at a willing-to pay (WTP) threshold of $12,367/QALY (1 GDP per capita), rising to 100% at $37,100/QALY (3 GDP per capita).

Conclusion: Alectinib appears to be the preferred cost-effective option in the adjuvant treatment for Chinese patients with resected early-stage ALK-positive NSCLC.