Cost-Effectiveness Analysis Of Ceritinib And Alectinib Versus Crizotinib In The Treatment Of Anaplastic Lymphoma Kinase-Positive Advanced Non-Small Cell Lung Cancer
Authors Liu M, Zhang L, Huang Q, Li N, Zheng B, Cai H
Received 16 July 2019
Accepted for publication 14 September 2019
Published 25 October 2019 Volume 2019:11 Pages 9195—9202
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Ahmet Emre Eskazan
Maobai Liu,1,* Longfeng Zhang,2,* Qishu Huang,3 Na Li,1 Bin Zheng,1 Hongfu Cai1
1Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, People’s Republic of China; 2Department of Medical Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian Province, People’s Republic of China; 3College of Pharmacy, Fujian Medical University, Fuzhou, Fujian Province, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Hongfu Cai
Department of Pharmacy, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, Fujian Province, People’s Republic of China
Background: This study aimed to analyze the cost-effectiveness of crizotinib versus ceritinib or alectinib as first-line-targeted drug therapy for anaplastic lymphoma kinase-positive advanced non-small cell lung cancer in China.
Methods: The Markov model was used to simulate the medical cost and quality-adjusted life years (QALYs) of patients using crizotinib, ceritinib, or alectinib over a 10-year period by establishing three health states: progression-free, post-progression, and death. Randomized controlled clinical data were collected from the open-label, randomized phase 3 trials ALEX and ASCEND-4. Cost and utility values were derived from local charges and literature. Sensitivity analyses included one-way and probabilistic sensitivity analyses.
Results: Compared with patients who used crizotinib as first-line treatment, patients in the ceritinib and alectinib groups yielded an additional 1.32 and 3.30 QALYs with an incremental cost of $84,728.20 and $339,114.36, respectively. Thus, the incremental cost-effectiveness ratio (ICER) was $64,398.83 and $102,675.74 per QALY in the ceritinib and alectinib groups, respectively. Alectinib was estimated to be more effective (4.68 QALY) and more costly ($432,063.06) with an ICER of $128,019.42 per QALY compared with ceritinib (2.69 QALY and $177,676.90). Results were robust to deterministic and probabilistic sensitivity analyses.
Conclusion: As a first-line treatment regimen, ceritinib and alectinib can extend the survival time of patients compared with crizotinib, but the medical cost also increases accordingly. According to the World Health Organization’s three-percent GDP measurement, first-line treatment with Crizotinib is the most cost-effective.
Keywords: crizotinib, ceritinib, alectinib, NSCLC, cost-effectiveness
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