University of Washington, 1959 NE Pacific St., H-375I, Box 357630, Seattle, WA, 98195-7630, USA.
F. Hoffmann-La Roche, Ltd, Basel, Switzerland.
Pharmacoeconomics. 2018 Apr;36(4):495-504. doi: 10.1007/s40273-018-0625-6.
The recently completed ALEX trial demonstrated that alectinib improved progression-free survival, and delayed time to central nervous system progression compared with crizotinib in patients with anaplastic lymphoma kinase-positive non-small-cell lung cancer. However, the long-term clinical and economic impact of using alectinib vs. crizotinib has not been evaluated. The objective of this study was to determine the potential cost utility of alectinib vs. crizotinib from a US payer perspective.
A cost-utility model was developed using partition survival methods and three health states: progression-free, post-progression, and death. ALEX trial data informed the progression-free and overall survival estimates. Costs included drug treatments and supportive care (central nervous system and non-central nervous system). Utility values were obtained from trial data and literature. Sensitivity analyses included one-way and probabilistic sensitivity analyses.
Treatment with alectinib vs. crizotinib resulted in a gain of 0.91 life-years, 0.87 quality-adjusted life-years, and incremental costs of US$34,151, resulting in an incremental cost-effectiveness ratio of US$39,312/quality-adjusted life-year. Drug costs and utilities in the progression-free health state were the main drivers of the model in the one-way sensitivity analysis. From the probabilistic sensitivity analysis, alectinib had a 64% probability of being cost effective at a willingness-to-pay threshold of US$100,000/quality adjusted life-year.
Alectinib increased time in the progression-free state and quality-adjusted life-years vs. crizotinib. The marginal cost increase was reflective of longer treatment durations in the progression-free state. Central nervous system-related costs were considerably lower with alectinib. Our results suggest that compared with crizotinib, alectinib may be a cost-effective therapy for treatment-naïve patients with anaplastic lymphoma kinase-positive non-small-cell lung cancer.
最近完成的 ALEX 试验表明，与克唑替尼相比，阿来替尼可改善间变性淋巴瘤激酶阳性非小细胞肺癌患者的无进展生存期，并延迟中枢神经系统进展时间。然而，尚未评估使用阿来替尼与克唑替尼相比的长期临床和经济影响。本研究的目的是从美国支付者的角度确定阿来替尼与克唑替尼相比的潜在成本效益。
使用分区生存方法和三种健康状态（无进展、进展后和死亡）开发了成本-效用模型。ALEX 试验数据为无进展生存期和总生存期估计提供了信息。成本包括药物治疗和支持性治疗（中枢神经系统和非中枢神经系统）。效用值从试验数据和文献中获得。敏感性分析包括单向和概率敏感性分析。
与克唑替尼相比，阿来替尼治疗可带来 0.91 个生命年、0.87 个质量调整生命年和 34151 美元的增量成本，导致增量成本效益比为 39312 美元/质量调整生命年。在单向敏感性分析中，无进展健康状态下的药物成本和效用是模型的主要驱动因素。从概率敏感性分析来看，阿来替尼在支付意愿阈值为 100000 美元/质量调整生命年时，有 64%的可能性具有成本效益。
与克唑替尼相比，阿来替尼增加了无进展状态和质量调整生命年的时间。边际成本的增加反映了无进展状态下治疗持续时间的延长。阿来替尼的中枢神经系统相关成本明显较低。我们的研究结果表明，与克唑替尼相比，阿来替尼可能是治疗初治间变性淋巴瘤激酶阳性非小细胞肺癌患者的一种具有成本效益的治疗方法。
