Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2019 ASCO Annual Meeting but not presented at the Meeting, can be found online only.
Economic evaluation of anaplastic lymphoma kinase (ALK) inhibitors brigatinib, alectinib and crizotinib in non-small cell lung cancer (NSCLC): Analysis for intracranial metastasis-related progression free survival (CNSPFS).
Metastatic Non-Small Cell Lung Cancer
Lung Cancer—Non-Small Cell Metastatic
2019 ASCO Annual Meeting
J Clin Oncol 37, 2019 (suppl; abstr e20515)
Author(s): Nimer S Alkhatib, Briana Choi, Elizabeth Pae, Hani M. Babiker, Linda L. Garland, Alyssa Henglefelt, Ali McBride, Ivo Abraham; University of Arizona, Tucson, AZ; University of Arizona College of Pharmacy, Tucson, AZ; University of Arizona Cancer Center, Tucson, AZ; Bannar University Medical Hospital, Tucson, AZ; Banner University Medical Center, Tucson, AZ
Background: ALK inhibitors (ALKI) have shown clinical benefit in preventing progression or death related to central nervous system (CNS) metastasis in NSCLC. We performed cost-effectiveness/utility analyses that consider CNS progression in comparing ALKIs. Methods: The Bücher method was used to indirectly estimate comparative hazard ratios (HR) for CNSPFS between the 3 agents. A 2-state Markov model (CNSPFS, CNS progression or death) was specified, survival curves were digitized, and Weibull distributions fitted with life time horizon. Drug costs were per RedBook (US$ 2018). Cost of adverse event management, disease progression and follow up were per published data. Outcomes included CNSPFS life years (CNSPFS LY) and quality adjusted life years (CNSPFS QALY). Incremental cost effectiveness/utility ratios (ICER/ICUR) of CNSPFS LY and CNSPFS QALY gained were estimated. Deterministic results were verified in probabilistic sensitivity analyses (PSA). Analyses were from the US payer perspective. Results: In indirect comparisons brigatinib was superior over crizotinib (CNSPFS HR = 0.27, 95%CI = 0.13-0.54) but comparable to alectinib (CNSPFS HR = 0.39, 95%CI = 0.12-1.31) in CNSPFS; whereas alectinib was comparable to crizotinib (CNSPFS HR = 0.68, 95%CI = 0.26-1.77). Deterministic (PSA) CNSPFS LY, CNSPFS QALY and cost estimates were 0.56 (0.69), 0.35 (0.42) and $126,430 ($153,870) for crizotinib; 0.68 (0.82), 0.39 (0.49) and $115,776 ($148,904) for alectinib; 0.80 (1.02), 0.51 (0.64) and $318,114 ($402,442) for brigatinib. See table for deterministic (PSA) ICER/ICUR results ($ in parentheses denote savings). Conclusions: This independent economic evaluation suggests that, despite the lower costs of per-label alectinib and crizotinib, greater gains in CNSPFS LYs and QALYs are achieved with per-label brigatinib in the setting of CNS metastasis. This assumes willingness to pay thresholds up to $1,152,445/CNSPFS LY and up to $1,198,025/CNSPFS QALY gained, which is above prevailing standards.
|ICER ($ per CNSPFS LY gained) (deterministic/PSA).|
|ICUR ($ per CNSPFS QALY gained) (deterministic/PSA)|