Zhang Meiling, Zheng Bei, Yang Wenjuan, Jiang Hong, Sun Xueshan, Zhao Zixuan, Li Gonghua, Dong Hengjin
Key Laboratory of Research and Development of Chinese Medicine of Zhejiang Province, Zhejiang Academy of Traditional Chinese Medicine, Hangzhou, Zhejiang, China.
Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, China.
Clin Med Insights Oncol. 2024 May 31;18:11795549241257234. doi: 10.1177/11795549241257234. eCollection 2024.
Lung cancer ranks first in both cancer incidence and mortality in China. The emergence of novel treatments for ALK-positive NSCLC led to an improvement in survival and quality of life for patients with advanced ALK mutation-positive non-small cell lung cancer (NSCLC). This study sought to assess the cost-effectiveness of 6 tyrosine kinase inhibitors (TKIs)-crizotinib, alectinib, ceritinib, brigatinib, ensartinib, and lorlatinib-as first-line treatments for ALK-positive NSCLC from the perspective of the Chinese health care system.
A Markov model was developed to estimate the cost-effectiveness of these 6 TKIs. In this model, ALK-positive NSCLC patients were initially simulated to receive 1 of the 6 TKIs as first-line therapy, followed by different TKIs as subsequent treatment and salvage chemotherapy as last-line treatment. Survival data were sourced from the latest published clinical trials. Costs were derived from recent national health insurance negotiations and hospital information systems of selected health care facilities. Utilities for healthy states and adverse events were obtained from the literature. One-way and probabilistic sensitivity analysis as well as scenario analysis was conducted to assess the robustness of the results.
Compared to ensartinib, crizotinib, alectinib, ceritinib, brigatinib, and lorlatinib demonstrated incremental quality-adjusted life years (QALYs) of -1.13, 0.39, -0.58, -0.09, and 0.35, respectively. The corresponding incremental costs were $10 677, $33 501, -$6426, $2672, and $24 358. This resulted in ICERs of -$9449/QALY, $85 900/QALY, $11 079/QALY, $29 689/QALY and $69 594/QALY, respectively.
Crizotinib was considered to be absolutely dominated by ensartinib. Under a willingness-to-pay threshold of $38 223/QALY, ceritinib and brigatinib were cost-effective compared with ensartinib, while lorlatinib and alectinib were not cost-effective when compared with ensartinib. Overall, brigatinib emerged as the most cost-effective treatment among all the options considered.
肺癌在中国的癌症发病率和死亡率中均居首位。ALK阳性非小细胞肺癌（NSCLC）新型治疗方法的出现，使晚期ALK突变阳性非小细胞肺癌患者的生存率和生活质量得到改善。本研究旨在从中国医疗保健系统的角度评估6种酪氨酸激酶抑制剂（TKIs）——克唑替尼、阿来替尼、色瑞替尼、布加替尼、恩莎替尼和劳拉替尼——作为ALK阳性NSCLC一线治疗的成本效益。
建立马尔可夫模型来估计这6种TKIs的成本效益。在该模型中，最初模拟ALK阳性NSCLC患者接受6种TKIs中的1种作为一线治疗，随后接受不同的TKIs作为后续治疗，并接受挽救性化疗作为最后一线治疗。生存数据来源于最新发表的临床试验。成本来自近期的国家医保谈判和选定医疗机构的医院信息系统。健康状态和不良事件的效用值从文献中获取。进行单向和概率敏感性分析以及情景分析，以评估结果的稳健性。
与恩莎替尼相比，克唑替尼、阿来替尼、色瑞替尼、布加替尼和劳拉替尼的增量质量调整生命年（QALYs）分别为-1.13、0.39、-0.58、-0.09和0.35。相应的增量成本分别为10677美元、33501美元、-6426美元、2672美元和24358美元。这导致增量成本效果比分别为-9449美元/QALY、85900美元/QALY、11079美元/QALY、29689美元/QALY和69594美元/QALY。
克唑替尼被认为绝对被恩莎替尼所主导。在支付意愿阈值为38223美元/QALY的情况下，与恩莎替尼相比，色瑞替尼和布加替尼具有成本效益，而与恩莎替尼相比，劳拉替尼和阿来替尼不具有成本效益。总体而言，在所有考虑的选项中，布加替尼是最具成本效益的治疗方法。
