To evaluate the cost-effectiveness of iruplinalkib for
ALK
-positive non-small cell lung cancer (NSCLC) patients who had not previously received
ALK
-tyrosine kinase inhibitors (TKIs) from the perspective of the Chinese healthcare system.
METHODS
2
Based on the INSPIRE clinical trial, a three-health state partitioned survival model was developed to simulate the progression of disease, with model cycle of 3 weeks and a life-year time range of 15 years; the discount rate was 5%. For the treatment of
ALK
-positive advanced NSCLC, total cost, quality-adjusted life year (QALY), and incremental cost-effectiveness ratio (ICER) were compared between iruplinalkib and crizotinib; using 1-3 times China’s per capita gross domestic product (GDP) (89 358-268 074 yuan) in 2023 as the willingness-to-pay (WTP) threshold, the cost-effectiveness of two regimens were compared. The sensitivity analysis and scenario analysis (altering the distribution of survival curves, utility values) were conducted to assess model robustness.
RESULTS
2
Compared with the crizotinib regimen, the ICER for the iruplinalkib regimen was 194 412.74 yuan/QALY, which was below the WTP threshold of three times China’s per capita GDP in 2023 (268 074 yuan). The results under the scenario of altering the survival curve distribution were consistent with the base case analysis. However, after increasing the utility value of the disease progression state, the ICER exceeded the WTP threshold, and iruplinalkib no longer had a cost-effective advantage. The results of the one-way sensitivity analysis indicated that the cost of iruplinalkib and the utility values of disease progression states had a significant impact on the ICER. The probabilistic sensitivity analysis confirmed the robustness of the base case analysis results.
CONCLUSIONS
2
From the perspective of China’s healthcare system, compared with crizotinib regimen, the therapy with iruplinalkib is cost-effective for
ALK
-positive NSCLC patients who have not previously received
HARATAKE N , TOYOKAWA G , SETO T , et al . The mechanisms of resistance to second- and third-generation ALK inhibitors and strategies to overcome such resistance [J ] . Expert Rev Anticancer Ther , 2021 , 21 ( 9 ): 975 - 988 .
SHI Y K , CHEN J H , YANG R X , et al . Iruplinalkib(WX-0593)versus crizotinib in ALK TKI-naive locally advanced or metastatic ALK-positive NSCLC:interim analysis of a randomized,open-label,phase 3 study(INSPIRE) [J ] . J Thorac Oncol , 2024 , 19 ( 6 ): 912 - 927 .
PICHON-RIVIERE A , DRUMMOND M , PALACIOS A , et al . Determining the efficiency path to universal health coverage:cost-effectiveness thresholds for 174 countries based on growth in life expectancy and health expenditures [J ] . Lancet Glob Health , 2023 , 11 ( 6 ): e833 - e842 .
BULLEMENT A , MENG Y , COOPER M , et al . A review and validation of overall survival extrapolation in health technology assessments of cancer immunotherapy by the National Institute for Health and Care Excellence:how did the initial best estimate compare to trial data subsequently made available? [J ] . J Med Econ , 2019 , 22 ( 3 ): 205 - 214 .
LU S , YE M , DING L , et al . Cost-effectiveness of gefitinib,icotinib,and pemetrexed-based chemotherapy as first-line treatments for advanced non-small cell lung cancer in China [J ] . Oncotarget , 2017 , 8 ( 6 ): 9996 - 10006 .
DAI Z , XU J , CHANG F , et al . The cost-effectiveness of iruplinalkib versus alectinib in anaplastic lymphoma kinase-positive crizotinib-resistant advanced non-small-cell lung cancer patients in China [J ] . Front Public Health , 2024 , 12 : 1333487 .
GUAN H J , LIU G , XIE F , et al . Cost-effectiveness of osimertinib as a second-line treatment in patients with EGFR-mutated advanced non-small cell lung cancer in China [J ] . Clin Ther , 2019 , 41 ( 11 ): 2308 - 2320 .
LIU W , HUO G , CHEN P . First-line tremelimumab plus durvalumab and chemotherapy versus chemotherapy alone for metastatic non-small cell lung cancer:a cost-effectiveness analysis in the United States [J ] . Front Pharmacol , 2023 , 14 : 1163381 .
NAFEES B , LLOYD A J , DEWILDE S , et al . Health state utilities in non-small cell lung cancer:an international study [J ] . Asia Pac J Clin Oncol , 2017 , 13 ( 5 ): e195 - e203 .
SHEN Y , WU B , WANG X , et al . Health state utilities in patients with advanced non-small-cell lung cancer in China [J ] . J Comp Eff Res , 2018 , 7 ( 5 ): 443 - 452 .
LIU M , ZHANG L , HUANG Q , et al . Cost-effectiveness analysis of ceritinib and alectinib versus crizotinib in the treatment of anaplastic lymphoma kinase-positive advanced non-small cell lung cancer [J ] . Cancer Manag Res , 2019 , 11 : 9195 - 9202 .
ALLEMANI C , MATSUDA T , DI CARLO V , et al . Global surveillance of trends in cancer survival 2000-14(CONCORD-3):analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries [J ] . Lancet , 2018 , 391 ( 10125 ): 1023 - 1075 .
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Related Author
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Related Institution
College of Basic Medicine, Chengdu University of TCM
Hainan Zhongwei Institute of Health Economy Development
Dept. of Infectious Disease, College of Clinical Medicine, Chengdu University of TCM
School of International Pharmaceutical Business, China Pharmaceutical University
Dept. of Pharmacy, the Second Affiliated Hospital of Wannan Medical College