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Anaplastic Lymphoma Kinase (ALK) inhibitors for Genetically Rearranged Non-Small Cell Lung Cancer: A Review of Cost-Effectiveness and Guidelines

Last updated: November 30, 2018
Project Number: RC1046-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the comparative cost-effectiveness of Anaplastic Lymphoma Kinase (ALK) inhibitors as the first-line therapy for patients with non-resectable Non-Small Cell Lung Cancer (NSCLC)?
  2. What is the cost-effectiveness of Anaplastic Lymphoma Kinase (ALK) inhibitors in patients with non-resectable Non-Small Lung Cancer (NSCLC) who disease has progressed on one or more ALK inhibitors during previous treatment?
  3. What are the evidence-based guidelines informing the use of Anaplastic Lymphoma Kinase (ALK) inhibitors in patients with non-resectable Non-Small Cell Lung Cancer (NSCLC)?

Key Message

A total of four economic evaluations and two clinical practice guidelines were included in this review, all were conducted well overall. One economic evaluation study and guideline were done in Canada, the remaining in the US.Findings from the economic evaluations indicated that alectinib and ceritinib were more cost-effective first-line treatments than crizotinib among patients without prior exposure to ALK-inhibitors. Among patients who were previously treated and had disease progression with crizotinib, alectinib was found to be more cost-effective compared with ceritinib, and ceritinib was more cost-effective compared with a number of treatment alternatives. In all instances, the incremental cost effectiveness ratio showed improved quality-adjusted life years with the more cost-effectiveness treatment option, a finding consistent at different willingness-to-pay thresholds. The included guidelines reported similar findings. Alectinib, ceritinib, and crizotinib are all recommended as the first-line treatment; however, alectinib is the preferred option among the three. Subsequent therapy may vary depending primarily on previous treatment; alectinib, ceritinib, or brigatinib are all recommended for patients who have been previously treated with crizotinib. For patients who have progressed on alectinib or ceritinib, subsequent therapy may include local therapy, cytotoxic chemotherapy, or continuation with other ALK-inhibitors. Above all, the guidelines state that clinical judgement and tolerability should be considered when determining the treatment sequence.