Crizotinib ‘Not Cost Effective’ for Advanced NSCLC

Canadian clinicians question the affordability of screening and treating lung cancer patients using drugs targeting rare biomarkers

medwireNews: Crizotinib therapy is not cost effective for the treatment of non-small-cell lung cancer (NSCLC) when assessed using Canadian public healthcare criteria.

Molecular testing and first-line treatment with the ALK-targeted agent for patients with stage IV, non-squamous NSCLC was associated with a 0.011 quality-adjusted life-years (QALY) gain compared with standard chemotherapy, report Natasha Leighl, from Princess Margaret Hospital in Toronto, Ontario, and co-authors.

Crizotinib therapy cost an additional Canadian $ 2725 per patient compared with standard treatment of first-line cisplatin plus gemcitabine, followed by second-line pemetrexed and third-line erlotinib, giving an incremental cost effectiveness ratio (ICER) of $ 255,970 per QALY gained.

For the 3–7% of advanced NSCLC patients who tested positive for the EML4–ALK fusion, first-line crizotinib gave an additional 0.379 QALYs over standard care at a further cost of $ 95,043 and an ICER of $ 250,632 per QALY gained.

The researchers note that these ICERs were based on Immunohistochemistry tumour testing for the EML4–ALK fusion in patients with a good performance status, and on crizotinib efficacy mirroring trial results. The conservative expectation was that first-line crizotinib would provide 7.7 months of survival over standard chemotherapy or 0.38 QALYs. However, if real-life treatment was less effective, the ICER would increase.

“The results of our study suggest that EML4–ALK fusion molecular testing and targeted crizotinib treatment for patients with advanced non-squamous NSCLC are currently not likely to be considered cost effective,” the team writes in the Journal of Clinical Oncology.

“Lower drug costs, more targeted molecular testing, or improved effectiveness would be required to make this strategy more economically feasible.”

In an accompanying editorial, Ronan Kelly, from the Sidney Kimmel Comprehensive Cancer Center in Baltimore, Maryland, USA, and co-authors question whether ALK screening and crizotinib are affordable when such a small proportion of patients are likely to benefit.

They acknowledge that ALK screening may become cost-effective with advances in technology. “But the elephant in the room is that society cannot continue to pay $10,000 per month for each new molecularly targeted drug,” the commentators note.

References

Djalalov S, Beca J, Hoch J et al. Cost effectiveness of EML4–ALK Fusion Testing and First-Line Crizotinib Treatment for Patients With Advanced ALK–positive Non-Small-Cell Lung Cancer. J Clin Oncol; Advanced online publication 24 February 2014. doi: 10.1200/JCO.2013.53.1186

Kelly R, Hillner B, Smith T. Cost-Effectiveness of Crizotinib for Anaplastic Lymphoma Kinase-Positive, Non-Small-Cell Lung Cancer: Who is going to blink at the cost? J Clin Oncol; Advance online publication 24 February 2014. doi: 10.1200/JCO.2013.54.6002

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