OBJECTIVES: Previous studies demonstrate high economic burden and 2.6 times the risk of death in patients with ALK+ advanced non-small-cell lung cancer (aNSCLC) with brain metastases (BM) compared with those without BM. This study estimates the annual costs of managing patients with ALK+ aNSCLC receiving lorlatinib, alectinib, brigatinib and crizotinib in Sweden.

METHODS: This study utilized results from a study performed in the UK where resource use frequencies of managing patients with ALK+ aNSCLC with and without BM were estimated. The resource use frequencies were combined with Swedish cost data to estimate the costs of managing patients in Sweden. The total annual cost with each TKI was estimated for the intention-to-treat (ITT) population by weighting the annual cost of managing patients with and without BM using 12-month, 24-month, 36-month and 48-month cumulative incidence of progression of BM in the CROWN, ALEX, and ALTA-1 trials (most updated data available).

RESULTS: Management costs were SEK 62,456 per patient-year (PPY) without BM and SEK167,121/SEK145,001 PPY with BM (first/subsequent year), resulting in cost savings of SEK104,665/82,545 PPY when BM are avoided. Lorlatinib’s annual cost savings per patient in year 1 versus crizotinib/alectinib/brigatinib were SEK25,094/SEK5,448/SEK7,594 in the ITT population. Cost savings increase over time. For example, cost savings with lorlatinib vs crizotinib increased 8 times in the ITT population, and 11 times in patients without baseline BM, from year 1 to year 4.

CONCLUSIONS: Consistent with the data from phase 3 trials where the cumulative incidence of BM progression with 1L lorlatinib is lower than other TKIs, these longitudinal cost data demonstrate that 1L lorlatinib leads to lower management cost of BM in ALK+ aNSCLC patients compared to other 1L TKIs. Cost savings increase significantly over time and are biggest in patients without baseline BM, reflecting the protective effect of lorlatinib on brain metastases.