Carlson J J, Canestaro W, Ravelo A, Wong W
a University of Washington , Seattle , WA , USA.
b Genentech, Inc. , South San Francisco , CA , USA.
J Med Econ. 2017 Jul;20(7):671-677. doi: 10.1080/13696998.2017.1302453. Epub 2017 Mar 23.
Introduction Anaplastic lymphoma kinase (ALK) targeting drugs provide an important option for advanced non-small cell lung cancer patients with this distinct tumor type; however, there is considerable uncertainty as to which drug provides the optimal value after crizotinib treatment. This study estimated the cost-utility of alectinib vs ceritinib from a US payer perspective. Methods A cost-utility model was developed using partition survival methods and three health states: progression-free (PF), post-progression (PP), and death. Survival data were derived from the key clinical trials (alectinib: NP28761 & NP28673, ceritinib: ASCEND I and II). Costs included drugs, adverse events, and supportive care. Utilities were based on trial data and the literature. One-way and probabilistic sensitivity analyses (PSA) were performed to assess parameter uncertainty. Results Treatment with alectinib vs ceritinib resulted in increases of 2.55 months in the PF state, 0.44 quality adjusted life-years (QALYs), and $13,868, yielding a mean cost/QALY of $31,180. In the PSA, alectinib had a 96% probability of being cost-effective at a willingness-to-pay of $100,000/QALY. Drivers of model results were drug costs and utilities in the PF health state. The ICER ranged from $10,600-$65,000 per QALY in scenario analyses, including a sub-group analysis limited to patients with prior chemotherapy and crizotinib treatment. Conclusions Treatment with alectinib in ALK + crizotinib-treated patients increased time progression-free and QALYs vs ceritinib. The marginal cost increase was driven by longer treatment durations with alectinib. This model demonstrates that alectinib may be considered a cost-effective treatment after progression on crizotinib.
间变性淋巴瘤激酶（ALK）靶向药物为患有这种独特肿瘤类型的晚期非小细胞肺癌患者提供了重要的治疗选择；然而，对于克唑替尼治疗后哪种药物能提供最佳价值存在相当大的不确定性。本研究从美国医保支付方的角度估计了阿来替尼与色瑞替尼的成本效益。方法：使用分区生存方法和三种健康状态（无进展、进展后和死亡）建立成本效益模型。生存数据来自关键临床试验（阿来替尼：NP28761和NP28673，色瑞替尼：ASCEND I和II）。成本包括药物、不良事件和支持性护理。效用基于试验数据和文献。进行单向和概率敏感性分析（PSA）以评估参数不确定性。结果：与色瑞替尼相比，阿来替尼治疗使无进展状态增加2.55个月，质量调整生命年（QALY）增加0.44，成本增加13,868美元，平均成本/QALY为31,180美元。在PSA中，阿来替尼在支付意愿为100,000美元/QALY时具有96%的成本效益概率。模型结果的驱动因素是无进展健康状态下的药物成本和效用。在情景分析中，包括仅限于接受过先前化疗和克唑替尼治疗的患者的亚组分析，增量成本效果比（ICER）为每QALY 10,600 - 65,000美元。结论：在ALK阳性且接受过克唑替尼治疗的患者中，与色瑞替尼相比，阿来替尼治疗可增加无进展时间和QALY。边际成本增加是由阿来替尼更长的治疗持续时间驱动的。该模型表明，在克唑替尼进展后，阿来替尼可被视为一种具有成本效益的治疗方法。
