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This section of First Report Managed Care focuses on reporting the latest in health care economics and outcomes research for a variety of treatments and disease states.

When comparing ceritinib and alectinib to crizotinib for treating patients with anaplastic lymphoma kinase (ALK) arrangement non-small-cell lung cancer (NSCLC), ceritinib proved to be the more cost-effective option.

Per prior research, crizotinib, ceritinib, and alectinib all improve survival in patients presenting with ALK-positive advanced NSCLC, but researchers from China Pharmaceutical University sought to better understand the long-term economic outcomes for each treatment.

The analysis used a Markov model to project the economic and health outcomes for the treatment of advanced NSCLC with ceritinib, alectinib or crizotinib. The researchers conducted a network meta-analysis to calculate hazard ratios of ceritinib and alectinib vs crizotinib by pooling published trials.

Cost- and utility-related data was collected from existing literature. Researchers conducted probabilistic sensitivity analyses to determine the potential robustness of the model’s outcomes. Primary outputs included total cost, life years (Lys), quality adjusted life years (QALYs), and incremental cost-effectiveness ratios.

Results of the study show that treatment with alectinib and ceritinib amounted to an additional 1.00 and 1.09 QALYs and incremental costs of $62,232 and $15,165, resulting in an incremental cost-effectiveness ratios of $62,231 and $13,905 per QALY compared with crizotinib, respectively.

“Parameters related to drug costs and progression-free survival were the main drivers of the model outcomes,” explained the researchers.

Further, “from the probabilistic sensitivity analysis, ceritinib and alectinib had a 99.9% and 0% probability of being cost effective, respectively, at a willingness-to-pay threshold of US$28,410/QALY.”

“Our results indicate that compared with crizotinib and alectinib, ceritinib is a cost-effective option for treatment-naïve patients with ALK-positive advanced NSCLC,” concluded the researchers.

—Edan Stanley 

Li H, Lai L, Wu B. Cost effectiveness of ceritinib and alectinib versus crizotinib in first-line anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer. Clin Drug Investig. 2020;40(2):183–189. doi:10.1007/s40261-019-00880-8

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