Cost-effectiveness analysis of anlotinib as a third-line or further treatment for advanced non-small cell lung cancer in China

Background: The health expenditure on treatment of advanced non-small cell lung cancer (NSCLC) is enormous, especially in third-line or further therapy. Cost-effectiveness analysis for the treatment of advanced NSCLC is particularly important. Anlotinib has been approved by the China Food and Drug Administration (CFDA) for the third-line or further treatment of advanced NSCLC. The price of anlotinib in China fell in 2022. Thus, this study evaluated the cost-effectiveness of anlotinib in the third-line or further treatment of patients with advanced NSCLC based on the newest price from the Chinese health-care system perspective.Methods: A Markov model was developed to compare the lifetime costs and effectiveness of anlotinib and a placebo in the third-line or further treatment of patients with advanced NSCLC based on outcome data from the ALTER 0303 phase-3 randomized clinical trial, which included 437 patients with advanced NSCLC and investigated the efficacy of anlotinib. The lifetime costs and quality-adjusted life years (QALYs) were estimated. One-way and probabilistic sensitivity analyses were performed to evaluate the model uncertainty.Results: Anlotinib provided an additional 0.1161 QALYs compared to the placebo. The corresponding incremental cost was yen 22,729. The incremental cost-effectiveness ratio (ICER) of anlotinib compared to the placebo was yen 195,768 per QALY. From the perspective of the Chinese health-care system, anlotinib was found to be cost-effective compared to the placebo in the third-line or further treatment of patients with advanced NSCLC at a willingness-to-pay (WTP) threshold of yen 242,928 per QALY. Moreover, 1-way sensitivity analysis found that the results were sensitive to the utility of progressive disease (PD). The lower this parameter was, the higher the probability of ICER for anlotinib not being cost-effective. The costeffectiveness acceptability curves showed that the base-case analysis results were relatively stable.Conclusions: Considering the clinical efficacy, safety, and cost-effectiveness of anlotinib, it may be a valuable third-line or further treatment for advanced NSCLC in China.