Presa María, Vicente David, Calles Antonio, Salinas-Ortega Laura, Naik Jaesh, García Luis F, Soto Javier
Health Economics, Pharmacoeconomics and Outcomes Research Iberia (PORIB), Madrid, Spain.
Medical Oncology Department, Hospital Universitario Virgen de Macarena, Sevilla, Spain.
Clinicoecon Outcomes Res. 2023 Sep 7;15:659-671. doi: 10.2147/CEOR.S415711. eCollection 2023.
The objective of the present study was to evaluate the efficiency of lorlatinib compared to alectinib and brigatinib for the treatment of adult patients with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC) previously not treated, in Spain.
A partitioned survival model comprised progression free, non-intracranial progression, intracranial progression, and death health states was constructed to estimate the total costs, life-years gained (LYG) and quality-adjusted life years (QALYs) accumulated in a lifetime horizon. Overall survival (OS) and progression-free survival (PFS) for lorlatinib were obtained from the CROWN study. For alectinib and brigatinib, a network meta-analysis of randomized controlled trials was conducted to estimate OS and PFS hazard ratios versus crizotinib. Utilities were estimated based on EQ-5D-5L data derived from the CROWN (lorlatinib), ALEX (alectinib) and ALTA-1L (brigatinib) studies. According to the Spanish National Health Service perspective the total costs (expressed in euros using a 2021 cost year) included drug acquisition and the administration's subsequent treatment, ALK+ advanced NSCLC management and adverse-event management, and palliative care. Unitary costs were obtained from local cost databases and literature. Costs, LYGs and QALYs were discounted at 3% annually. Deterministic and probabilistic sensitivity analyses were used to test the model's robustness.
Lorlatinib provided higher health outcomes (+0.70 LYG/patient, +1.42 QALYs/patient) and lower costs (-€9239/patient) than alectinib. Lorlatinib yielded higher LYG (+1.74) and QALYs (+2.30) versus brigatinib but higher costs/patient (+€36,627), resulting in an incremental-cost-effectiveness-ratio of €15,912/QALY gained.
The results of this study suggest that lorlatinib may be a dominant treatment option versus alectinib. Considering a willingness-to-pay threshold of €25,000/QALY, lorlatinib may be an efficient option compared to brigatinib.
本研究的目的是在西班牙评估洛拉替尼与阿来替尼和布加替尼相比，用于治疗既往未接受过治疗的间变性淋巴瘤激酶（ALK）阳性晚期非小细胞肺癌（NSCLC）成年患者的疗效。
构建了一个包含无进展、非颅内进展、颅内进展和死亡健康状态的分区生存模型，以估计在终身范围内累积的总成本、获得的生命年（LYG）和质量调整生命年（QALY）。洛拉替尼的总生存期（OS）和无进展生存期（PFS）数据来自CROWN研究。对于阿来替尼和布加替尼，进行了随机对照试验的网络荟萃分析，以估计与克唑替尼相比的OS和PFS风险比。效用值基于来自CROWN（洛拉替尼）、ALEX（阿来替尼）和ALTA-1L（布加替尼）研究的EQ-5D-5L数据进行估计。从西班牙国家卫生服务的角度来看，总成本（以2021年成本年度的欧元表示）包括药物采购以及管理部门随后的治疗、ALK+晚期NSCLC管理和不良事件管理以及姑息治疗。单位成本来自当地成本数据库和文献。成本、LYG和QALY按每年3%进行贴现。使用确定性和概率敏感性分析来检验模型的稳健性。
与阿来替尼相比，洛拉替尼带来了更高的健康效益（每位患者+0.70 LYG，每位患者+1.42 QALY）和更低的成本（每位患者-€9239）。与布加替尼相比，洛拉替尼产生了更高的LYG（+1.74）和QALY（+2.30），但每位患者的成本更高（+€36,627），导致每获得一个QALY的增量成本效果比为€15,912。
本研究结果表明，与阿来替尼相比，洛拉替尼可能是一种更具优势 的治疗选择。考虑到每QALY的支付意愿阈值为€25,000，与布加替尼相比，洛拉替尼可能是一种有效的选择。
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