Cost-effectiveness of ceritinib in previously untreated anaplastic lymphoma kinase-positive metastatic non-small cell lung cancer in the United States. (3rd June 2018)

• Record Type: Journal Article
• Authors: Zhou, Zheng-Yi; Mutebi, Alex; Han, Simeng; Bensimon, Arielle G.; Louise Ricculli, Marie; Xie, Jipan; Dalal, Anand; Culver, Ken
• Is Part Of: Journal of medical economics. Volume 21:Number 6(2018)
• Page Start: 577
• Page End: 586
• Publication Date: 2018-06-03
• Subjects: Anaplastic lymphoma kinase-positive -- non-small cell lung cancer -- ceritinib -- crizotinib -- cost-effectiveness; Medical care -- Cost control -- Periodicals; Medical economics -- Periodicals; 362.10941
• DOI: 10.1080/13696998.2018.1443111
• Languages: English
• ISSNs: 1369-6998

Abstract

Abstract: Aims: To assess the cost-effectiveness of first-line ceritinib vs crizotinib and platinum doublet chemotherapy for anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (NSCLC) from a US third-party payer's perspective. Materials and methods: A partitioned survival model with three health states (stable disease, progressive disease, death) was developed over a 20-year time horizon. Ceritinib's efficacy inputs (progression-free and overall survival) were estimated from ASCEND-4; parametric survival models extrapolated data beyond the trial period. The relative efficacy of ceritinib vs chemotherapy was obtained from ASCEND-4, the relative efficacy of ceritinib vs crizotinib was estimated using a matching-adjusted indirect comparison based on ASCEND-4 and PROFILE 1014. Drug acquisition, treatment administration, adverse event management, and medical costs were obtained from publicly available databases and the literature, and inflated to 2016 US dollars. Treatment-specific stable-state utilities were derived from trials and progressive-state utility from the literature. Incremental costs per quality-adjusted life year (QALY) were estimated for ceritinib vs each comparator. Cost-effectiveness was assessed based on US willingness-to-pay thresholds. Deterministic and probabilistic sensitivity analyses were performed to test model robustness. Results: In the base case, first-line ceritinib was associated with total direct costs of $299, 777 and 3.28 QALYs (from 4.61 life years gained [LYG]) over 20 years. First-line crizotinib and chemotherapy were associated with 2.73 and 2.41 QALYs, 3.92 and 3.53 LYG, and $263, 172 and $228, 184 total direct costs, respectively. The incremental cost per QALY gained was $66, 064 for ceritinib vs crizotinib and $81, 645 for ceritinib vs chemotherapy. In the first 2 years following treatment initiation, ceritinib dominated crizotinib by conferring greater health benefits at reduced total costs. Results were robust to deterministic and probabilistic sensitivity analyses. Limitations: In the absence of head-to-head trials, an indirect comparison method was used. Conclusions: Ceritinib is cost-effective compared to crizotinib and chemotherapy in the treatment of previously untreated ALK-positive metastatic NCSLC in the US.