OBJECTIVES: This study estimates the costs of managing brain metastases (BM) in patients with ALK-positive advanced non-small-cell lung cancer (aNSCLC) receiving lorlatinib, crizotinib, and alectinib as first-line treatment in China.

METHODS: More than 40 clinical experts from tertiary hospitals across 18 regions in China were surveyed by questionnaire on healthcare resources utilization (HCRU) in ALK-positive aNSCLC patients with and without BM. HCRU included surgical resection, radiotherapy, medical visits, hospitalizations, laboratory tests, imaging, and ALK gene tests. Diagnostic tests and treatment costs were excluded. The costs are derived from expert estimation. The total annual costs with TKIs were estimated by weighting the annual costs of managing patients with and without BM using the ITT population cumulative incidence rate (CIR) of BM progression in CROWN and ALEX trials.

RESULTS: In the first year after diagnosis, the annual management cost was ￥36,204 per patient-year without BM and ￥117,731 with BM, resulting in cost savings of ￥81,527. The biggest driver is hospitalization cost. Applying the 12-month CIR of BM progression, lorlatinib exhibited higher savings vs. crizotinib by ￥52,911 in patients with BM, ￥13,696 without BM. Patients without BM had 1.4/2.7/3.5 times increased in annual cost savings at 24/36/48 months of loratinib treatment compared to 12 months. Alectinib reduces management costs vs. crizotinib by ￥34,486 in patients with BM, ￥21,931 in patients without BM based on 12-month CIR from ALEX trial. No data on cumulative incidence of BM progression beyond 12 months were available for alectinib.

CONCLUSIONS: Due to the lower CIR of BM progression with lorlatinib, significant savings in annual BM management costs were observed from year 1 to 4 in patients who received first-line lorlatinib in China, and are biggest in patients without BM, consistent with the known BM protective effect of lorlatinib.