Cost-Effectiveness of Ceritinib Versus Current Therapies for Chemotherapy-Experienced Anaplastic Lymphoma Kinase Positive Non-Small Cell Lung Cancer Patients in Mexico

Abstract

OBJECTIVES: Patients with non-small cell lung cancer (NSCLC) who have the ana-plastic lymphoma kinase (ALK) gene rearrangement can be treated with crizotinib (CRZ); however, resistance can eventually occur. Ceritinib (CRT) is a novel ALK inhibitor with substantial efficacy in ALK+ NSCLC patients, even among those who have progressed after CRZ treatment. A recent trial (ASCEND-1) demonstrated that previously-treated, crizotinib-naive (PT/CN-EX) ALK+ NSCLC patients treated with CRT had a median progression-free survival of 15.2 months, with 73.1% of patients responding to therapy. The objective of this study was to project the health and cost-effectiveness outcomes of CRT versus current therapies in chemotherapy-experienced (CM-EX) Mexican ALK+ NSCLC patients. METHOD(S): A partitioned survival model simulated PT/CN-EX ALK+ NSCLC patients over a 20 year time horizon. Patients received therapy in a progression-free state before transitioning to a progressive-disease state where patients stayed until death. Patients either received CRT or one of the following therapies: CRZ, pemetrexed monotherapy (PM), docetaxel monotherapy (DM), and pemetrexed-carboplatin (PC). Survival data were fit and extrapolated from the ASCEND-1 trial for CRT with hazard ratios against comparators sourced via naive indirect comparisons. Relevant cost and resource utilization data were sourced from the literature and adjusted to 2014 MXN pesos. All outcomes were discounted at 5%. RESULT(S): Compared to current therapies in Mexico, CRT improved health outcomes over 20 years, resulting in the most quality-adjusted life-years (QALYs: CRT: 2.49, CRZ: 1.62, PM: 0.64, DM: 0.68, and PC: 0.74). In addition, CRT was projected to be cost-effective, with incremental cost-effectiveness ratios ranging from MXN 375,458 (vs. CRZ) to MXN 610,125 (vs. PC). Deterministic and probabilistic sensitivity analyses demonstrated that results were robust across model inputs and assumptions. CONCLUSION(S): CRT was projected to result in the best health outcomes for PT/CN-EX ALK+ NSCLC patients compared to current treatment regimens in Mexico, while also being a cost-effective therapy.