Lorlatinib as a first-line treatment of adult patients with anaplastic lymphoma kinase-positive advanced non-small cell lung cancer: cost-effectiveness analysis in Greece

ObjectivesTo evaluate the cost-effectiveness of lorlatinib compared to 1st generation anaplastic lymphoma kinase (ALK) TKI crizotinib, and 2nd generation TKIs alectinib and brigatinib, for previously untreated patients with ALK+ advanced Non-Small Cell Lung Cancer (aNSCLC).MethodsA partitioned survival model was locally adapted from a Greek payer perspective over a lifetime horizon. Clinical, safety and utility data were extracted from literature. Direct medical costs reflecting the year 2023 were included in the analysis (euro). Model outcomes were patients' life years (LYs), quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratios (ICERs).ResultsTotal cost per patient with lorlatinib, alectinib, crizotinib, and brigatinib was estimated to be euro188,205, euro183,343, euro75,028, and euro145,454 respectively. Lorlatinib appeared to yield more LYs and QALYs gained versus alectinib, crizotinib, and brigatinib. Hence, lorlatinib resulted in ICERs of euro4,315 per LY gained and euro4,422 per QALY gained compared to alectinib, euro34,032 per LY gained and euro48,256 per QALY gained versus crizotinib and euro16,587 per LY gained and euro26,271 per QALY gained compared to brigatinib.ConclusionLorlatinib provides substantial clinical benefit and appears to be a cost - effective treatment option compared to 1st and 2nd generation TKIs for previously untreated patients with ALK+ aNCSLC in Greece.