OBJECTIVES : Study aim is to evaluate the cost-effectiveness of alectinib compared to crizotinib for the treatment of naïve patients with ALK-positive Non-small Cell Lung Cancer (NSCLC) in the Colombian health system setting.

METHODS : Two decision analysis models were used to represent the natural history of first-line treatment of ALK-positive NSCLC: a) a decision tree model with one-year horizon due to the prevalence ofbrain metastases at the beginning of treatment (≈26%); b) a global partitioned survival model with a 5-year time horizon, adapted tothe local setting. Outcomes were life-years gained (LYG) and quality-adjusted life years (QALY). Both were calculated from overall and progression-free survival previously published in the ALEX trial. The direct medical costs were obtained from a standard Colombian national public health tariff in addition to information from a health insurance company administrative database with national coverage. They were expressed in US dollars (Exchange rate 2019: COP 3281.09 = US$1)

RESULTS : For the decision tree (first year), the incremental LYG was 0.07 in favor of alectinib with a US$4,874 saving. The incremental cost-effectiveness ratio (ICER) showed alectinib as a cost-saving alternative (-US$ 553,782.86/LYG). In the partitioned survival model (5 years), the incremental LYG was 0.55 in favor of alectinib with a US$ 27,960.27 saving. The ICER showed alectinib as the most cost-saving alternative (-US$ 51,317.82/LYG). The incremental QALY was 0.60 in favor of alectinib and the ICER is a cost-saving alternative(-US$45,564.48/QALY).

CONCLUSIONS : Alectinib, as a first-line treatment of ALK+ NSCLC compared to crizotinib, is a cost-saving alternative in the Colombian setting.