Cost-effectiveness analysis of first-line treatment with crizotinib in ROS1-rearranged advanced non-small cell lung cancer (NSCLC) in copyright
Cost-effectiveness analysis of first-line treatment with crizotinib in ROS1-rearranged advanced non-small cell lung cancer (NSCLC) in copyright
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Abstract Introduction While no direct comparative data exist for crizotinib in ROS1+ non-small cell viqua-f4 lung cancer (NSCLC), studies have suggested clinical benefit with this targeted agent.The objective of this study was to assess the cost-effectiveness of crizotinib compared to standard platinum-doublet chemotherapy for first-line treatment of ROS1+ advanced NSCLC.Methods A Markov model was developed with a 10-year time horizon from the perspective of the Canadian publicly-funded health care system.
Health states included progression-free survival (PFS), up to two further lines of therapy post-progression, palliation and death.Given a lack of comparative data and small study samples, crizotinib or chemotherapy studies with advanced ROS1+ NSCLC patients were identified and time-to-event data from digitized Kaplan-Meier curves were collected to pool PFS data.Costs of drugs, treatment administration, monitoring, adverse events and palliative care were included in 2018 Canadian dollars, with 1.
5% discounting.An incremental cost-effectiveness ratio (ICER) was estimated probabilistically using 5000 simulations.Results In the base-case probabilistic analysis, crizotinib produced additional 0.
885 life-years and 0.772 quality-adjusted life-years (QALYs) at an incremental cost of $238,077, producing pure energy jeans an ICER of $273,286/QALY gained.No simulations were found to be cost-effective at a willingness-to-pay threshold of $100,000/QALY gained.
A scenario analysis assuming efficacy equivalent to the ALK+ NSCLC population showed a slightly more favorable cost-effectiveness profile for crizotinib.Conclusions Available data appear to support superior activity of crizotinib compared to chemotherapy in ROS1+ advanced NSCLC.At the list price, crizotinib was not cost-effective at commonly accepted willingness-to-pay thresholds across a wide range of sensitivity analyses.