ESMO Asia Congress 2022

Abstract 311P

Background

Alectinib demonstrated significantly improved clinical outcomes in patients with anaplastic lymphoma kinase-positive (ALK+) advanced non-small-cell lung cancer (NSCLC) in a randomized Phase III trial (ALEX). There is no study examining long-term health and economic outcomes of this first-line treatment of ALK+ advanced NSCLC compared with chemotherapy that has been a standard of care in Thailand.

Methods

A partitioned survival model consisted of 3 health states (progression-free survival, post-progression survival, and death) was developed. Costs were obtained from literature from the Thai setting. Clinical outcomes were obtained from a network meta-analysis of related published trials. All outcomes and costs were estimated from a provider perspective over a 35-year time horizon and discounted at 3% annually. One-way and probabilistic sensitivity analyses were carried out to determine robustness of the findings. The Thai willingness-to-pay (WTP) threshold at $4,520/quality-adjusted life-years (QALY) was applied.

Results

The estimated mean overall survivals were 5.97 years for alectinib and 3.3 years for chemotherapy. The alectinib and chemotherapy provided 3.75 and 1.68 QALY, respectively. The total lifetime costs for alectinib and chemotherapy were $105,254 and $24,068. The incremental cost-effectiveness ratio (ICER) were $30,390/life-year and $39,205/QALY.

Conclusions

The model showed that alectinib has provided almost double increases in clinical benefits over chemotherapy as the current standard of care. Alectinib has been a standard of care in many settings where the treatment is demonstrated as a cost-effective option. Alectinib for treating Thai patients exceeds the current WTP threshold and it would result in limited access to this treatment.