OBJECTIVES: Patients with anaplastic lymphoma kinase-positive (ALK+) advanced non-small cell lung cancer (aNSCLC) are at high risk of developing brain metastases (BM), thus entailing significant clinical and economic burden. The aim of this study was to estimate the annual cost of managing aNSCLC ALK+ patients with and without BM and compare the relevant costs of BM patients treated with alectinib or lorlatinib in Greece.

METHODS: An excel-based model with one-year time horizon was adapted to evaluate the management cost of ALK+ aNSCLC patients with and without BM. A proportion of patients develops BM based on cumulative annual incidence of BM extracted from the ALEX trial for alectinib and the CROWN trial for lorlatinib. Resource utilization of patients with and without BM included diagnostic/laboratory tests, medical visits, hospitalizations, and medical procedures associated with BM treatment, as sourced from a published study. Direct medical costs (€,2023) were extracted from official publicly available Greek sources.

RESULTS: An annual management cost of €936.85 per patient was estimated for ALK+ aNSCLC patients without BM, and €2,904.68 per patient for those with BM. The presence of BM was associated with an annual cost increase of €1,967.82 per patient compared to non-BM, due to increased monitoring and resource utilization. Moreover, treatment with lorlatinib was associated with an annual management cost reduction of €130 per patient compared to alectinib due to lower BM incidence.

CONCLUSIONS: Analysis results link lorlatinib’s lower 12-month cumulative incidence of progression of BM with lower healthcare resource utilization compared to alectinib and therefore translates to cost-savings from payer’s perspective. As BM are common in ALK+ aNSCLC, there is a crucial need for treatments that have protective effect against BM development and delay CNS progression. Additionally, these treatments may offer benefits for the healthcare systems since management cost of ALK+ aNSCLC patients is higher when BM are present.