Efficacy of alectinib in comparison with lorlatinib in patients with ALK-positive non-small cell lung cancer: pharmacoeconomic study

Objective: to evaluate the clinical and economic effectiveness of alectinib in comparison with lorlatinib in adult patients with advanced anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer (NSCLC). Materials and methods. The calculations included the direct costs of the healthcare system: the costs of drug therapy, detecting and relieving adverse events, palliative care. A Markov model consisting of three patient states (“alive without progression”, “alive with progression”, “death”) was constructed, the probabilities of which were obtained from previously conducted clinical studies. Due to the equivalence of strategies regarding overall and non-progressive survival, the cost minimization analysis was applied. Results. The total costs per 1 patient when using lorlatinib were 40.63% higher than for alectinib (12,551,770 and 7,451,522 rubles, respectively). At the same time, the difference was mainly determined by different costs of targeted therapy: in the alectinib group, the cost of drug therapy per 1 patient amounted to 6,646,247 rubles, in lorlatinib group – to 11,922,814 rubles (44% higher). Conclusion. The use of alectinib in the treatment of patients with ALK-positive NSCLC is justified not only from clinical, but also from an economic point of view.