OBJECTIVES: Analyze the economic consequences of implementing alectinib as an adjuvant treatment for ALK+ non-small cell lung cancer (NSCLC). Alectinib has recently been approved in the adjuvant setting with the potential to reduce disease recurrence. This analysis aims to illustrate the potential saving of subsequent treatment lines by implementing alectinib as a postoperative standard of care in ALK+ NSCLC from a reimbursement perspective.

METHODS: A semi-Markov model delineating disease-free survival, (non)metastatic recurrence, first-, and second-line treatments and death using a 40-year time horizon was developed. Both deterministic and probabilistic sensitivity analyses were conducted to demonstrate the robustness of findings.

RESULTS: Replacing chemotherapy with alectinib as adjuvant treatment for ALK+ NSCLC will generate a cost of approximately € 25.500 per patient. Alectinib has the potential to reduce the number of recurrences and the number of patients requiring treatment by offering patients better clinical outcomes and personalized therapy in the adjuvant setting. Thus, the cost of alectinib in the adjuvant setting is almost offset by reducing costs in subsequent treatment lines while at the same time generating an average QALY gain of 3.6 for each patient. The DSA and PSA show that the results are robust and most sensitive to the assumption of when a patient is considered to be cured (5 years of disease-free survival), the proportion of patients with disease recurrence after adjuvant treatment, and the assumption on rechallenging with an ALK-TKI. In Denmark, the expected number of patients is limited to less than 10 patients per year, so the budget impact will be very minimal. Analysis is based on list prices.

CONCLUSIONS: Alectinib is highly cost-effective with a limited budget impact as an adjuvant treatment for ALK+ NSCLC patients, as the cost of alectinib is almost completely offset by reducing the cost of treating patients in the metastatic setting.