Abstract
Objectives
To evaluate the cost-effectiveness of crizotinib in the treatment of ALK-positive non-small cell lung cancer (ALK+NSCLC) in the Portuguese NHS.
Methods
A previously developed and validated state transition Markov cohort model was used. The economic model was adapted to consider treatment strategies relevant to Portuguese setting and clinical practice. The economic model was adapted to consider treatment strategies relevant to the Portuguese clinical practice and populated with relevant epidemiological, quality of life and economic/resource use data; the latter mainly driven by evidence elicited from a panel of six Portuguese clinical experts with extensive clinical experience. First-line treatment with pemetrexed and platinum followed by switch to crizotinib (second-line) and best-supportive-care (third-line) in case of disease progression was compared with first-line treatment with crizotinib followed by switch to docetaxel (second-line) and best-supportive-care (third-line). Unit costs (medicines, procedures and hospitalizations) were extracted from Portuguese official sources. A societal perspective was adopted. Both costs and effects were discounted at 5%, and a lifetime horizon was considered. Univariate sensitivity analyses were performed over key model parameters.
Results
A treatment strategy considering crizotinib as first-line option was found to be more costly per patient, but also more effective than one considering first-line pemetrexed and platinum for patients with ALK+NSCLC. This resulted in an incremental cost-effectiveness ratio (ICER) of 29326 € per LY gained (48691 € per QALY gained). Sensitivity analyses over key model parameters indicated that the base case results were generally robust.
Conclusions
Compared with standard first-line chemotherapy, first-line treatment with crizotinib in patients with ALK+NSCLC can be considered a cost-effective option for the Portuguese NHS by commonly used criteria in oncology.
To evaluate the cost-effectiveness of crizotinib in the treatment of ALK-positive non-small cell lung cancer (ALK+NSCLC) in the Portuguese NHS.
Methods
A previously developed and validated state transition Markov cohort model was used. The economic model was adapted to consider treatment strategies relevant to Portuguese setting and clinical practice. The economic model was adapted to consider treatment strategies relevant to the Portuguese clinical practice and populated with relevant epidemiological, quality of life and economic/resource use data; the latter mainly driven by evidence elicited from a panel of six Portuguese clinical experts with extensive clinical experience. First-line treatment with pemetrexed and platinum followed by switch to crizotinib (second-line) and best-supportive-care (third-line) in case of disease progression was compared with first-line treatment with crizotinib followed by switch to docetaxel (second-line) and best-supportive-care (third-line). Unit costs (medicines, procedures and hospitalizations) were extracted from Portuguese official sources. A societal perspective was adopted. Both costs and effects were discounted at 5%, and a lifetime horizon was considered. Univariate sensitivity analyses were performed over key model parameters.
Results
A treatment strategy considering crizotinib as first-line option was found to be more costly per patient, but also more effective than one considering first-line pemetrexed and platinum for patients with ALK+NSCLC. This resulted in an incremental cost-effectiveness ratio (ICER) of 29326 € per LY gained (48691 € per QALY gained). Sensitivity analyses over key model parameters indicated that the base case results were generally robust.
Conclusions
Compared with standard first-line chemotherapy, first-line treatment with crizotinib in patients with ALK+NSCLC can be considered a cost-effective option for the Portuguese NHS by commonly used criteria in oncology.
| Original language | English |
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| DOIs | |
| Publication status | Published - 2017 |