Cost-Effectiveness of Crizotinib for First-Line Treatment in Non-Small Cell Lung Cancer in Ecuador

Non-small cell lung cancer (NSCLC) represents 85% of all lung tumors and is the leading cause of cancer death with a significant economic impact worldwide. Many lung cancers do not respond to conventional therapy, therefore other treatment alternatives such as biological drugs are used to stop its damage and progression and to improve patient’s lifetime. Crizotinib has evidenced efficacy for the locally advanced or metastatic NSCLC based on the presence of ALK or ROS1 but it is not yet covered and reimbursed by the Ecuadorian public health system. The present study purposed to evaluate the cost-effectiveness of crizotinib in the first line treatment of locally advanced or metastatic NSCLC compared with the standard chemotherapy (pemetrexed with cisplatin or carboplatin) in public hospitals in Ecuador. A Markov model was developed, based on duration of response rates reported in the 2014 study of Solomon. The dosing schedule of oral crizotinib was 250 mg twice daily versus intravenous standard chemotherapy (pemetrexed, 500 mg/m², plus cisplatin, 75 mg/m², or carboplatin, target area under the curve of 5-6 mg/ml/min) every 3 weeks for up to six cycles. All costs were taken from the Ecuadorian Reference Costs (2017) and doses were calculated for a standard Ecuadorian patient (1.73m² of body surface area). The total costs for crizotinib treatment were 60,447.2 USD vs. 7,780.8 USD for pemetrexed + carboplatin and 6,592.7 for pemetrexed + cisplatin. The efficacy was determined by the duration of response (years) (0.94 for crizotinib vs. 0.44 for standard chemotherapy). The ICER for crizotinib was 105,332.80 USD compared to pemetrexed + carboplatin and 107,709.00 USD compared to pemetrexed + cisplatin. The ICER values obtained in this analysis can be considered as acceptable for the Ecuadorian public health system because of the high efficacy of crizotinib treatment.