Brigatinib is a cost-effective treatment in first-line anaplastic lymphoma kinase mutation-positive (ALK + ) advanced non-small cell lung cancer (NSCLC) with brain metastases

2022 ◽  
pp. 107815522110734
Author(s):  
Jacopo Giuliani
Keyword(s):  
Lung Cancer ◽  
Cost Effectiveness ◽  
Brain Metastases ◽  
Cost Effective ◽  
Small Cell ◽  
Control Group ◽  
Small Cell Lung ◽  
First Line ◽  
Anaplastic Lymphoma ◽  
Kinase Mutation

Introduction The aim of this paper was to assess the cost-effectiveness of alectinib and brigatinib in first-line for anaplastic lymphoma kinase mutation-positive (ALK+) advanced non-small cell lung cancer (NSCLC). Pivotal phase III RCTs were considered. Four hundred and eighty-two patients were included. Both trials, which compared alectinib and brigatinib versus (vs.) crizotinib (control group), respectively, showed a gain in pharmacological costs, compared to the control group, of 194.80 € for alectinib and 648.48 € for brigatinib for an entire treatment of a single patient. Brigatinib was the less expensive, with a cost of 269.78 € for each month of PFS for both intention-to-treat (ITT) population that patients with baseline brain metastases (BBM). In conclusion, combining pharmacological costs of drugs with the measure of efficacy represented by PFS, both alectinib and brigatinib are cost-effective treatments in first-line for ALK+ NSCLC. In the BBM population brigatinib seems to be the most cost-effectiveness.

scholarly journals Cost-Effectiveness of Domestic PD-1 Inhibitor Camrelizumab Combined With Chemotherapy in the First-Line Treatment of Advanced Nonsquamous Non–Small-Cell Lung Cancer in China

2021 ◽  
Vol 12 ◽  
Author(s):  
Liu Qiao ◽  
Zhen Zhou ◽  
Xiaohui Zeng ◽  
Chongqing Tan
Keyword(s):  
Lung Cancer ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Transition Probabilities ◽  
Secondary Analysis ◽  
Cost Effective ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Primary Analysis

Objective: Camrelizumab is the first domestic PD-1inhibitor approved to be combined with chemotherapy as a first-line therapy for advanced nonsquamous non–small-cell lung cancer (NSCLC) in China. The purpose of this study was to determine whether using camrelizumab in the first-line setting is cost-effective in China when compared with traditional chemotherapy or the imported PD-1inhibitor pembrolizumab.Material and Methods: A Markov model was built to simulate 3-week patient transitions over a 30-year horizon from the perspective of the Chinese healthcare system. Health states included stable disease, first progression, second progression, and death. A direct comparison between first-line camrelizumab in combination with pemetrexed and carboplatin (CPC) and pemetrexed plus carboplatin (PC) was performed by calculating transition probabilities from the CameL trial. An indirect comparison between first-line CPC and pembrolizumab in combination with pemetrexed and platinum (PPP) was performed by calculating transition probabilities using a network meta-analysis. Costs in the Chinese setting were collected from the local public database and literatures. Sensitivity analyses explored the uncertainty around model parameters.Results: In the primary analysis, first-line CPC gained an additional 0.41 quality-adjusted life-years (QALYs) with an incremental cost of $3,486 compared with PC, resulting in an incremental cost-effectiveness ratio (ICER) of $8,378 per QALY gained. In the secondary analysis, first-line PPP yielded an additional 0.10 QALYs at an incremental cost of $6,710, resulting in an ICER of $65,563 per QALY gained.Conclusion: For Chinese patients with advanced nonsquamous NSCLC without targetable genetic aberrations, our primary analysis results supported first-line CPC as a cost-effective treatment compared with traditional PC chemotherapy. The findings of our secondary analysis suggested that first-line PPP would not be a cost-effective option compared with first-line CPC. This analysis provided strong evidence for promoting the widespread use of first-line CPC in China and, to some extent, stimulated the enthusiasm for the development of domestic cancer drugs.

scholarly journals Cost-Effectiveness of Lorlatinib as a First-Line Therapy for Untreated Advanced Anaplastic Lymphoma Kinase-Positive Non-Small Cell Lung Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
SiNi Li ◽  
JianHe Li ◽  
LiuBao Peng ◽  
YaMin Li ◽  
XiaoMin Wan
Keyword(s):  
Lung Cancer ◽  
Cost Effectiveness ◽  
Anaplastic Lymphoma Kinase ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Anaplastic Lymphoma ◽  
First Line Therapy ◽  
Line Therapy ◽  
Life Years

IntroductionRecently, a phase III CROWN trial compared the efficacy of two anaplastic lymphoma kinase (ALK) inhibitors and demonstrated that lorlatinib displayed clinical improvement over crizotinib for advanced non-small cell lung cancer (NSCLC) patients. Therefore, the aim of this study was to estimate the cost-effectiveness of lorlatinib as a first-line therapy for patients with advanced ALK-positive (+) NSCLC.Materials and MethodsA cost-effectiveness analysis was performed using a microsimulation model from the US payer perspective and a lifetime horizon (30 years) in patients with previous untreated advanced ALK+ NSCLC. Based on the CROWN trial, patient characteristics were obtained, and the transition probabilities were estimated. All direct costs were derived from official sources and published literature. The main outcomes of the model were total costs, incremental cost-effectiveness ratio (ICER), quality-adjusted life years (QALYs), and life years (LYs). One-way and probabilistic sensitivity analyses and multiple scenario analyses were conducted to test the robustness of the model outcomes.ResultsIn the base case analysis, in which 1 million patients were simulated, treatment with lorlatinib or crizotinib as the first-line treatment was related to a mean cost of $909,758 and $616,230 (incremental cost: $293,528) and a mean survival of 4.81 QALYs and 4.09 QALYs (incremental QALY: 0.72) per patient, respectively. The main drivers of cost effectiveness were drug price and subsequent cost. PAS indicated that lorlatinib has 90% cost-effectiveness when compared to crizotinib when the willingness-to-pay (WTP) threshold in increased to $448,000/QALY. Scenario analysis demonstrated that lorlatinib has 100% cost-effectiveness at a WTP threshold of 200,000/QALY compared to crizotinib treatment when the price of lorlatinib is decreased to 75% ($424.5) of its original price.ConclusionsIn this study, lorlatinib was unlikely to be cost effective compared with crizotinib for patients with previously untreated advanced ALK+ NSCLC at a WTP threshold of 200,000/QALY.

scholarly journals Optimal sequencing strategies in the treatment of EGFR mutation–positive non–small cell lung cancer: Clinical benefits and cost-effectiveness

2020 ◽  
Vol 77 (18) ◽  
pp. 1466-1476
Author(s):  
Vera Hirsh ◽  
Jaspal Singh
Keyword(s):  
Lung Cancer ◽  
Cost Effectiveness ◽  
First Generation ◽  
Egfr Mutation ◽  
Cost Effective ◽  
Small Cell ◽  
Small Cell Lung ◽  
First Line ◽  
Optimal Sequencing ◽  
Egfr Tkis

Abstract Purpose To summarize current understanding of the efficacy, role, and cost-effectiveness of the available epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), and to evaluate sequencing strategies based on the available evidence. Summary. EGFR TKIs are the current standard of care for patients with EGFR mutation–positive non–small cell lung cancer (NSCLC). Five EGFR TKIs are currently approved in the United States for use in a first-line setting; these TKIs differ in mechanism of action, efficacy, safety, and cost. Most patients develop resistance to first-line EGFR TKIs and require subsequent therapy with additional EGFR TKIs, chemotherapy, and/or other targeted agents. A major consideration when selecting EGFR TKIs, both as first-line or subsequent treatment options, is cost-effectiveness. Although clinical trials have shown that the second- and third-generation EGFR TKIs are superior in efficacy to the first-generation agents, pharmacoeconomic studies suggest that the first-generation agents are the most cost-effective, with the second-generation TKI afatinib also considered cost-effective in some studies. Despite its impressive efficacy, osimertinib appears to be less cost-effective due to substantially higher acquisition costs. Conclusion Preliminary data suggest that first-line afatinib followed by osimertinib may offer promising survival outcomes and, on the basis of efficacy alone, may represent an optimal sequencing strategy in the majority of patients with EGFR mutation–positive NSCLC, in particular Asian patients and those with Del19-positive tumors. However, considerably more research into outcomes and costs associated with consecutive sequencing of EGFR TKIs is needed before any conclusions can be reached.

scholarly journals Cost-effectiveness analysis of the first-line EGFR-TKIs in patients with non-small cell lung cancer harbouring EGFR mutations

2019 ◽  
Vol 21 (1) ◽  
pp. 153-164 ◽  
Author(s):  
Marscha S. Holleman ◽  
Maiwenn J. Al ◽  
Remziye Zaim ◽  
Harry J. M. Groen ◽  
Carin A. Uyl-de Groot
Keyword(s):  
Lung Cancer ◽  
Cost Effectiveness ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Cost Effective ◽  
Small Cell ◽  
Egfr Mutations ◽  
Small Cell Lung ◽  
First Line ◽  
The Cost

Abstract Objectives To compare the cost-effectiveness of first-line gefitinib, erlotinib, afatinib, and osimertinib in patients with non-small cell lung cancer (NSCLC) harbouring epidermal growth factor receptor (EGFR) mutations. Methods A systematic review and network meta-analysis (NMA) were conducted to compare the relative efficacy of gefitinib, erlotinib, afatinib, and osimertinib in EGFR-mutated NSCLC. To assess the cost-effectiveness of these treatments, a Markov model was developed from Dutch societal perspective. The model was based on the clinical studies included in the NMA. Incremental costs per life-year (LY) and per quality-adjusted life-year (QALY) gained were estimated. Deterministic and probabilistic sensitivity analyses (PSA) were conducted. Results Total discounted per patient costs for gefitinib, erlotinib, afatinib, and osimertinib were €65,889, €64,035, €69,418, and €131,997, and mean QALYs were 1.36, 1.39, 1.52, and 2.01 per patient, respectively. Erlotinib dominated gefitinib. Afatinib versus erlotinib yielded incremental costs of €27,058/LY and €41,504/QALY gained. Osimertinib resulted in €91,726/LY and €128,343/QALY gained compared to afatinib. PSA showed that gefitinib, erlotinib, afatinib, and osimertinib had 13%, 19%, 43%, and 26% probability to be cost-effective at a threshold of €80,000/QALY. A price reduction of osimertinib of 30% is required for osimertinib to be cost-effective at a threshold of €80,000/QALY. Conclusions Osimertinib has a better effectiveness compared to all other TKIs. However, at a Dutch threshold of €80,000/QALY, osimertinib appears not to be cost-effective.

Cost effectiveness of ceritinib in patients previously treated with crizotinib and chemotherapy with anaplastic lymphoma kinase positive (ALK+) non-small cell lung cancer (NSCLC) in the United States

2021 ◽  
Author(s):  
Yichen Zhang ◽  
Yixue Shao ◽  
Charles Stoecker ◽  
Lizheng Shi
Keyword(s):  
Lung Cancer ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
The United States ◽  
Small Cell ◽  
Small Cell Lung ◽  
Anaplastic Lymphoma ◽  
The Us ◽  
Previously Treated ◽  
Nsclc Patients

Abstract BackgroundLung cancer is the leading cause of cancer death in the United States. Among non-small cell lung cancer (NSCLC) patients with anaplastic lymphoma kinase mutation (ALK+) and who were resistant to crizotinib, ceritinib was approved as a following treatment. Ceritinib was found to be cost effective among Canadian patients, but its cost effectiveness among US population remains unknown.ObjectiveTo evaluate the cost-effectiveness of ceritinib versus chemotherapy among ALK+ NSCLC patients who received treatment of crizotinib and chemotherapy, from the US healthcare perspective.MethodsA Markov model with three health states (progression-free, progression, and death) and a partitioned survival analysis model (PartSA) were developed, respectively. Survival functions, including progression free survival and overall survival, for ceritinib and chemotherapy were extrapolated from clinical trials ASCEND-2, ASCEND-5, and PROFILE-1007. Costs for the drugs, monitoring, and adverse events, and utilities at each health state were derived from published literature. Costs were inflated to 2018 US dollars. An annual discount rate of 3% was applied to costs and utilities, and a 5-year time horizon was applied to the analysis. Incremental cost per quality-adjusted life year (QALY) gained for ceritinib versus chemotherapy was estimated with $150,000/QALY as the US willingness-to-pay threshold. Sensitivity analyses (i.e., one-way sensitivity analysis and probabilistic sensitivity analysis) were conducted to test the uncertainties of the models.ResultsBoth models find ceritinib yields fewer QALYs than chemotherapy. The Markov model indicates modest cost-savings of ceritinib when compared to chemotherapy (-$3,131) and small declines in health (-1.04 QALYs) ($3008.39 per QALY lost). The PartSA model indicates additional costs of ceritinib when compared to chemotherapy ($12,884.95) and similar declines in health (-0.87 QALYs), indicating a dominated strategy. Both models were most sensitive to parameters of medical cost for progression disease and cost of ceritinib.ConclusionsCeritinib is not cost effective compared to chemotherapy among patients who were previously treated with crizotinib and chemotherapy, from the US healthcare perspective.

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