Cost-effectiveness of ceritinib in previously untreated ALK-positive advanced non-small cell lung cancer in Hong Kong

Abstract

Background: Ceritinib (CERI) has demonstrated in the ASCEND-4 phase III trial to improve progression free survival (PFS) compared with chemotherapy in previously untreated lymphoma kinase-positive (ALK+) advanced non-small cell lung cancer (NSCLC). The ASCEND-8 bioequivalence trial confirmed similar pharmacokinetics and better safety profile with a lower dose of CERI at 450mg daily with food. Our objective is to assess the cost-effectiveness of CERI versus crizotinib in the treatment of ALK+ NSCLC in Hong Kong (HK). Methods: A partitioned survival model with three health states was built to evaluate costs and effectiveness associated with first-line treatment with CERI. Efficacy inputs (PFS and OS) of CERI were estimated using data from ASCEND-4 and extrapolated beyond the trial period using parametric survival models. Relative efficacy of CERI vs. CRIZO was estimated using matching-adjusted indirect comparison based on ASCEND-4 and PROFILE 1014 data. Frequencies of adverse events were obtained from an interim analysis of the ASCEND-8 (cut-off: 26/7/17). Drug acquisition, administration and medical costs associated with each health state were obtained. The incremental cost effectiveness ratio (ICER) per quality-adjusted life years (QALYs) was the main outcome. Deterministic and probabilistic sensitivity analyses were performed to test the robustness of the results. Results: ICER for CERI as a first line treatment for ALK+ NSCLC was USD 13,343 compared with CRIZO. The resulting ICER is significantly lower than the WHO threshold of three times gross domestic product (GDP) per capita (currently at USD 119,274) and below the local ICER threshold reported for HK (USD 24,302 – 40,202) . Results were robust to sensitivity analyses, including analysis to obtain frequencies of adverse events from ASCEND-4 trial data (ICER of USD17,051). Conclusions: Compared with CRIZO, CERI offers a cost-effective option in the treatment of previously untreated ALK+ advanced NSCLC in HK.