Analisi costo-efficacia di alectinib versus crizotinib nel trattamento di prima linea del carcinoma polmonare non a piccole cellule (NSCLC) avanzato per la chinasi del linfoma anaplastico (ALK) positivo

Background. Alectinib has recently been approved for the treatment of advanced Anaplastic Lymphoma Kinase (ALK)-positive Non-Small-Cell Lung Cancer (NSCLC), since it was superior to crizotinib (the standard of care) in terms of progression-free survival, central nervous system progression and overall survival. This study aimed to analyze cost-effectiveness of alectinib versus crizotinib as first-line targeted drug therapy for advanced ALK-positive NSCLC. Material and methods. A decision-tree model based on Progression-Free Survival (PFS) and disease progression data from head-to-head clinical study, ALEX, was developed to compare alectinib and crizotinib. The study was conducted in the Italian healthcare setting, over a time horizon of 12 months. The Incremental Cost-Effectiveness Ratio (ICER), the Net Monetary Benefit (NMB) and the Incremental Net Monetary Benefit (INB) were compared, respectively, to a Willingness- To-Pay (WTP) of € 50.000, according to the guidelines of the National Institute for Health and Care Excellence (NICE). Furthermore one-way sensitivity analyses were performed to assess parameter uncertainty. Results. Indexing the costs of the treatment for the probability of survival or disease progression, the total theoretical cost of alectinib and crizotinib therapy were, respectively, € 88.857,85 and € 80.823,25. ICER, expressed as incremental cost per life year gained, was € 42.287,37, thus falling within the favorable cost-effectiveness ratio, being lower than WTP. This was also confirmed by NMB, which was € 1.465,4. Oneway sensitivity analyses showed that the main drivers of model outcomes were drug cost-related parameters. Conclusion. This model demonstrated that alectinib may be considered a cost-effective option with respect to crizotinib for the treatment of naive patients with advanced ALK-positive NSCLC. This study, however, does not take into account direct (related to clinical, instrumental, laboratory monitoring of patients and possible cases of death), as well as indirect healthcare costs.